Bladder function before and after selective dorsal rhizotomy in children with cerebral palsy.

Abstract

Approximately a third of children with cerebral palsy are expected to present with dysfunctional voiding symptoms. Selective dorsal rhizotomy, which is indicated for managing lower extremity spasticity in children with cerebral palsy, also has the potential of affecting bladder function. We evaluate the impact of selective dorsal rhizotomy on bladder function by comparing preoperative and postoperative symptoms, and urodynamic parameters in children undergoing selective dorsal rhizotomy for spasticity. We reviewed urodynamic studies in 25 boys and 15 girls with a mean age plus or minus standard deviation of 5.43+/-2.1 years who underwent selective dorsal rhizotomy for spasticity at our institution between January 1992 and September 1995. Urodynamics were performed preoperatively only in 22 patients, preoperative and postoperatively in 13, and postoperatively only in 5. Preoperative urodynamic studies were done within 2 weeks of surgery and postoperative studies were done at least 6 months after surgery (mean 1.32+/-0.65 years). Of the 35 patients with preoperative urodynamic studies total bladder capacity, pressure specific volumes and full resting pressure were abnormal for age in 23 (65.7%). In addition, 17 of the 23 children (74%) were completely asymptomatic. In the group that underwent preoperative and postoperative urodynamic studies there was significant improvement in total bladder capacity (p <0.005) and pressure specific volumes (p <0.005) using the paired Student t test. All children had neurological improvement postoperatively, 5 of 7 (71%) who were incontinent preoperatively became continent and none had deterioration on urodynamics. At least half of the children with spastic cerebral palsy have clinically silent bladder dysfunction. Selective dorsal rhizotomy improves spasticity and significantly improves bladder storage characteristics. We propose that urodynamic studies be included in the evaluation of children with spastic cerebral palsy who are possible candidates for selective dorsal rhizotomy to treat lower limb spasticity.