Urologic outcomes in children with closed spinal dysraphism with and without untethering of the spinal cord

Closed spinal dysraphism (CSD) comprises a heterogeneous group of congenital anomalies that may remain asymptomatic or present with neurological and urological dysfunction. This study aimed to evaluate long-term urological outcomes in children with isolated CSD and to compare outcomes between patients managed conservatively and those who underwent spinal cord untethering (SCU).

We conducted a retrospective cohort study of children with CSD treated at Helsinki University Hospital between 1990 and 2015.

Forty-three patients were followed for a median of 11.0 years. Urological symptoms were common, and at some point during follow-up, 21 patients (49%) required urological treatment. At the end of follow-up, 27 patients (63%) required no ongoing urological treatment. Before SCU or during conservative treatment, 82% (32/39) of patients older than three years achieved volitional voiding, and 72% (28/39) were continent; 18% required clean intermittent catheterization (CIC), and 19% (7/39) received bladder-directed therapy. Twenty patients underwent neurosurgical spinal cord untethering, most often due to progressive symptoms. Seventeen patients (85%) had volitional voiding preoperatively, whereas only 10 patients (50%) voided volitionally at the last follow-up after SCU (p = 0.02). At the last follow-up, there was no significant difference in the need for urological treatment between conservatively treated patients and those who underwent SCU. All patients had normal kidney function at the last follow-up.

A substantial proportion of children with CSD require urological treatment during long-term follow-up. Despite postoperative changes in bladder function, long-term urological treatment needs were similar between conservatively managed patients and those who underwent SCU.