Long-term follow-up in spinal dysraphism: outcome of renal function and urinary and faecal continence

This study evaluated the renal and functional outcome in a cohort of adolescents with congenital spinal malformations followed at this department since birth. All patients went through same follow-up and algorithm of intervention during childhood. None of the patients was treated prophylactically, apart from receiving antibiotics.

Sixty children (31 males, 29 females), born in 1989-1995, were evaluated from June 2006 to May 2007. Ultrasound of the bladder and the upper urinary tract was performed in all patients. Surgical and pharmacological intervention, bowel function, faecal and urinary continence were registered. Renal function was assessed by (51)Cr-EDTA and/or MAG-3 scintigraphy in patients who had previously experienced affected renal function or presented with deteriorated bladder function.

Two children died during follow-up. In total, 47 urological procedures were performed in 23 patients. The most frequently conducted procedures were appendicovesicostomy (n = 11) and autoaugmentation (n = 11). Fourteen patients underwent untethering procedures, resulting in improved bladder function in five patients; nine were unaltered. Five patients had a moderate and two a severe decrease in glomerular filtration rate. Eighty-one per cent were performing clean intermittent catheterization, starting at a median age of 3.6 years. Anticholinergics were used in 50%. Sixty-two per cent were totally urine continent, 22% used incontinence pads in case of leakage and 16% were urine incontinent. Two patients had Malone procedures; 29% were using trans-anal irrigation. Eighty-three per cent were totally faecal continent.

Close follow-up and appropriate intervention have improved renal function in children with congenital spinal malformation, but renal deterioration remains a risk. Total faecal and urinary continence could be achieved in 81% and 62%, respectively.