[Urologic complications in sacrococcygeal agenesis]

In 11 children with partial sacrococcygeal agenesis without concurrent patent cystic myelomeningocele clinical symptoms were analyzed as well as the character of dysfunction of the bladder and therapeutic results. The cause of urinary incontinence, which was a constant symptom, was not diagnosed correctly in six children. Due to impaired innervation, mostly of the supranuclear type, the bladder dysfunction had more frequently the character of impaired evacuation (8 children) always with obstruction of the flow at the level of the external sphincter. Areflexia of the detrusor was found in three children. In this group changes of the upper urinary pathways were found in four children (three times unilateral reflux, twice dilated ureters, twice also pyelonephritis), always in conjunction with a bladder of low compliance. The impaired storage of urine found in three children was due to hyperreflexia of the bladder. After surgery (three children), conservative treatment (8 children) and their combination progression of changes of the upper urinary pathways was arrested and the degree of incontinence improved or was completed relieved during the 18-78-month follow-up of all patients. Extirpation of the associated subcutaneous lipomyelomeningocele and release of the attached spinal cord in three children aged 5, 10 and 12 years did not lead to improvement of the nervous lesion in any of the patients.