Ongenital Medullary Malformations and Urinary Disorders: The Contribution of Urodynamic Assessment in the Diagnostic, Prognostic and Theurapeutic Approach in the Light of Recommendations and The Literature

Abstract

Congenital medullary malformations or spinal dysraphisms are anomalies in the closure of the neural tube affecting the spinal column and the spinal cord. The cause is usually multifactorial. The main cause of morbidity and mortality in these children is renal deterioration. This is the main cause of neurological bladder in children. Urinary management must begin early, from the neonatal period, with the aim of preserving the urinary tract and renal function, as vesico-sphincter imbalance is the cause of renal deterioration and may therefore be life-threatening for these children. Urodynamic investigation is the key examination for analysing the functioning of the lower urinary tract and proposing a course of treatment based on the mechanisms of vesicosphincter dysfunction. There are still very few publications on urodynamics in children. Although urodynamic exploration techniques differ little from those used in adults, the pathophysiology of bladder and bowel function in infants is specific to this age group. This article reviews the literature to demonstrate the value of urodynamic testing in the diagnosis and treatment of urinary disorders in congenital medullary malformations.