The spectrum of spinal cord dysraphism and bladder neuropathy in children

The frequency of bladder neuropathy and its relationship to abnormalities of the neural axis on MR scan was examined in a group of 49 children with known occult spinal dysraphism and 148 children with daytime urinary incontinence. Of the patients with known spinal dysraphism 55% had bladder neuropathy. There was no relationship between either the type of abnormality or the number of abnormalities seen on MR scan and the presence or absence of bladder neuropathy. 5 of the 9 patients with a normal cord had neuropathic bladders. Four of the 148 patients with daytime wetting turned out to have spinal dysraphism. Of the rest, 51 patients required urodynamic studies and of these 12 had clearcut bladder neuropathy. 15 patients had MR scans, all of which were normal. The range of urodynamic findings in those with bladder neuropathy was identical to the range found in patients with spinal dysraphism. On the basis of these findings it is suggested that children with isolated bladder problems could well have spinal cord dysraphism as a cause of these - the lesions being beyond the resolution of MR scanning. For those children with clearcut spinal dysraphism the absence of any relationship between the bladder findings and the lesion places a question mark over the potential benefits of neurosurgical intervention.