Risk factors for renal function impairment in a series of 502 patients born with spinal dysraphisms Michele Torre a, *, Edoardo Guida a , Giovanni Bisio a , Piero Scarsi a , Gianluca Piatelli b , Armando Cama b , Piero Buffa a a Pediatric Surgery Unit, G. Gaslini Institute, Genova, Italy b Neurosurgery Unit, G. Gaslini Institute, Genova, Italy Received 1 December 2009; accepted 22 February 2010 Available online 2 April 2010 KEYWORDS Spina bifida; Neurogenic bladder; Renal function; Spinal dysraphism; Caudal regression syndrome Abstract Objective: To evaluate the risk of renal damage in a large series of patients affected by spinal dysraphism. Methods: Renal function was studied in 502 spinal dysraphisms treated over the last 25 years in a single center: 283 meningomyelocele (MMC), 90 caudal regression syndrome (CRS) and 129 spinal lipoma (SL) cases. In patients with normal and impaired renal function, we compared congenital renal anomalies, vesicoureteric reflux, bladder voiding pattern and upper tract dila- tation, analyzing the results with the Fisher test. Results: Neuropathic bladder was observed in 97% of MMC, 60% of CRS, and 39% of SL cases. There was some degree of renal function impairment in 19 MMC (6.7%), 11 CRS (12%, increased to 20% if considering only neuropathic bladder patients), and two SL (1.5%) cases. Renal agen- esis was more frequent in CRS (13%), but was not associated with decreased renal function. Overall, vesicoureteric reflux and upper tract dilatation were more frequent in patients with renal damage. Insufficient bladder voiding was statistically associated with renal damage only in the CRS population. Intermittent catheterization did not represent a protective factor against renal damage in patients able to void without significant residual urine. Conclusion: This study has increased our understanding of the prognostic risk factors for renal deterioration. More prospective studies are necessary to confirm these results and correlate treatment with renal outcome. ª 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. * Corresponding author at: Dr. Michele Torre, Pediatric Surgery Unit, G. Gaslini Institute, Largo G. Gaslini, 16148 Genova, Italy. Tel.: þ39 0105636446/392 217; fax: þ39 0103075092. E-mail addresses: micheletorre@hotmail.com, micheletorre@ospedale-gaslini.ge.it (M. Torre). 1477-5131/$36 ª 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2010.02.210 Journal of Pediatric Urology (2011) 7, 39e43