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Renal function and urinary/faecal incontinence - Long-term follow-up in spinal dysraphism (Abstract)

Bettina Jørgensen¹, Lars Henning Olsen², Troels Munch Jørgensen²
¹Institute of Clinical Medicine, Aarhus University Hospital - Skejby, Denmark
²Department of Urology, Section of Pediatric Urology, Aarhus University Hospital - Skejby, Denmark



A cohort of adolescents with congenital spinal malformations followed at our department were evaluated in terms of renal and functional outcome. All patients went through same follow up and algorithm of intervention during childhood. None of the patients were not treated profylactically besides from antibiotics.
Material and methods: Sixty children (31 males, 29 females), born 1989-1995, were evaluated from June 2006 to may 2007. Ultrasound of the bladder and the upper urinary tract was performed in all patients. Surgical and pharmacological intervention, bowel function, faecal and urinary continence were registered. Renal function was assessed by 51Cr-EDTA and/or MAG-3 scintigraphy in patients who earlier experienced renal affection or were presenting with deteriorated bladder function.
Results: Two children died during follow up. A total of 47 urological procedures were performed in 23 patients. Most frequently conducted were appendicovesicostomy (n=11) and autoaugmentation (n=11). Fourteen patients underwent untethering procedures, resulting in improved bladder function in 5 patients, 9 were unaltered. Five patients had a moderate and 2 a severe decrease in GFR. Eighty-one percent were performing CIC, starting at median age 3.6 years. Anticholinergics were used in 50%. Sixty-two % were totally urine continent, 22% used incontinence pads in case of leakage and 16% were urine incontinent. Two patients had Malone procedures, 29% were using trans-anal-irrigation. Eighty-three percent were totally faecal continent.
Conclusion: Close follow up and appropriate intervention has improved renal function in children with congenital spinal malformation but renal deterioration remains at risk. Total faecal and urinary continence could be achieved in 81% and 62%, respectively.
key words: neurogenic bladder, renal function, continence


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