NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Early Spinal Cord Untethering and Anorectal Malformation Reconstruction Does Not Adversely Effect Lower Urinary Tract Function
Carlos R. Estrada, M.D.1, Ali Dokucu, M.D.1, Joseph G. Borer, M.D.1, Shahram Koshbin, M.D.2, Stuart B. Bauer, M.D.1.
1Children's Hospital Boston, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA,

Background: Lower urinary tract dysfunction in children with anorectal malformation (ARM) is common. We asked 1) what is the influence of ARM with or without anatomic sacrospinal pathology (SSP) on lower urinary tract (LUT) function? and 2) does early spinal cord surgery and/or anorectal reconstruction adversely affect LUT function?
Methods: From 1998-2005 24 infants with ARM were evaluated. Of these, 12 underwent magnetic resonance imaging (MRI) to evaluate sacrospinal anatomy, and pre- and post-operative urodynamic studies (UDS) with electromyography (EMG) of the external urethral sphincter. Only patients with SPP underwent neurosurgical correction. ARM reconstruction was performed in all patients. UDS were performed in all patients prior to and following any neurosurgical or ARM reconstructive procedure to document and monitor LUT function.
Results: ARM included high (10/12) and low (2/12) imperforate anus. MRI revealed SPP in 10/12 (83%) patients, with tethering in 9 of these. SPP was unrelated to the type of ARM. All children with SPP initially had normal neurological examinations. Preoperative UDS demonstrated normal LUT function in 11/12 (92%). 1 patient had detrusor sphincter dyssynergy (DSD) but normal EMG activity at rest and normal sacral reflexes. Neurosurgical correction was performed at a mean age 9 months (4-27 mos.) and ARM reconstruction was performed at a mean age 10.5 months (2-24 mos.). Postoperative UDS were performed at a mean 8.4 months after the last surgery. All postoperative UDS were normal, including the patient with prior DSD.
Conclusions: The majority of children with ARM have anatomic sacrospinal neuropathology. Despite this, almost all have a normal neurological examination, LUT function, and UDS. Early spinal cord untethering and/or ARM reconstruction does not adversely affect LUT function and may be protective of future deterioration.


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