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Urodynamic findings in children with spinal cord ischemia
J E Batista1, S B Bauer, J M Shefner
1Children's Hospital, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Purpose:
We identified urodynamic patterns of lower urinary tract dysfunction in children after anterior spinal artery injury.
Materials And Methods:
Between 1981 and 1993, 6 boys and 1 girl in whom ischemic spinal cord injuries developed after umbilical artery catheterization (4), cardiovascular surgery (2) and spontaneous bleeding from an arteriovenous fistula (1) were evaluated radiologically, neurologically and urodynamically.
Results:
Neurological assessment revealed a motor level from T8 to S1 in all 7 children, whereas only 3 had sensory denervation ranging from T8 to L4. Urodynamic studies demonstrated a mixed upper and lower motor neuron pattern in 3 patients, a lower motor neuron lesion only in 3 and a pure upper motor neuron deficit in 1. Treatment consisted of oxybutynin in 5 cases, Credé voiding in 1 and close observation in 1. All children are dry and kidney function has remained stable.
Conclusions:
Spinal cord ischemia in children is a rare condition that can arise from a variety of causes, the most common of which are embolism from umbilical artery catheterization and surgical repair of a patent ductus arteriosus. The urodynamic patterns are variable but characteristically they can be upper or lower motor neuron in nature. Precise testing will lead to appropriate therapy to prevent upper urinary tract disease and minimize incontinence.