Neuropathic bladder and spinal dysraphism

The association between spinal dysraphism and a neuropathic bladder is well known, but the diagnosis of the spinal lesion and the associated renal problems is often delayed. Four children referred with orthopaedic problems and in whom the bladder abnormally proved to be the major disability are described. Despite widely differing vertebral involvement, all had lower motor neurone neurological deficits confined to lumbar and upper sacral segments. All had unstable, variably thickened, small bladders, and it is proposed that the bladder abnormality is the result of a partial lesion of lumbosacral innervation, and not of an upper motor neurone lesion.