SPINAL ABNORMALITIES IN CLASSIC BLADDER EXSTROPHY

Objective To determine the frequency and clinical sequelae of signific ant spinal malformations in children born with classic bladder exstrop hy, Patients and methods All patients evaluated or treated for classic bladder exstrophy at this institution were reviewed retrospectively. Radiographs or reports pertinent to the spine were retrieved and revie wed with a paediatric radiologist and all vertebral abnormalities cate gorized. Clinical charts of those with spinal anomalies were reviewed to determine any clinical neurological disorders associated with the r adiographic findings. Results Of 423 patients with classic bladder exs trophy who were identified, 299 had radiographs or reports available f or adequate review. Of these, 34 (11%) normal variants, e.g. spina bif ida occulta and lumbarization or sacralization of vertebrae, were iden tified, Abnormalities of spinal curvature were identified in eight pat ients (2.7%), all with uncomplicated scoliosis. Spinal dysraphism was diagnosed in 12 patients (4%) and included myelomeningocele, lipomenin gocele, scimitar sacrum, posterior laminal defects in two or more vert ebrae, vertebral fusion and hemivertebrae. The one patient with myelom eningocele had clinical neurological dysfunction, giving an overall in cidence of 0.3%. Conclusions Spinal anomalies, excluding normal varian ts, occur in children born with classic bladder exstrophy at a rate of about 6.7%. The incidence of this association is much less than that for cloacal exstrophy. Although rare, neurological dysfunction can occ ur in the case of spinal dysraphism. Paediatric urologists and neurolo gists should be aware of this significant difference between patients with classic bladder and cloacal exstrophy to properly diagnose, evalu ate and treat the attendant neurological problems.