Long-term followup of newborns with myelodysplasia and normal urodynamic findings: Is followup necessary?

Purpose: A subset of newborns with myelodysplasia have normal bladder funct ion on urodynamic assessment. We analyzed long-term followup in this popula tion to determine the necessity for subsequent urological surveillance. Materials and Methods: We retrospectively analyzed the records of 25 of 204 newborns (12%) with myelodysplasia in whom neurourological evaluation was normal after surgical repair of the spinal defect. Initial assessment inclu ded complete urodynamic study, renal ultrasound, urinalysis and urine cultu re. These patients were reevaluated every 3 months until age 3 years, semia nnually until age 6 years and yearly thereafter. The longest followup was 1 8.6 years. Results: Of the 25 newborns 22 had myelomeningocele and 3 had meningocele. During a mean followup of 9.1 years urodynamics subsequently showed neurour ological deterioration in 8 children (32%). No changes in urodynamics were observed in any patient older than 6 years. All children with neurourologic al deterioration underwent magnetic resonance imaging, which confirmed a te thered spinal cord that was then surgically corrected. After the untetherin g procedure 2 patients (25%) regained normal voiding function, whereas in 6 (75%) mild or moderate neurogenic bladder dysfunction persisted. Conclusions: Newborns with myelodysplasia and initially normal urodynamic s tudies are at risk for neurological deterioration secondary to spinal cord tethering, especially during the first 6 years of life. Close followup of t hese children is important for the early diagnosis and timely surgical corr ection of tethered spinal cord, and for the prevention of progressive urina ry tract deterioration.