Development of hydronephrosis in spina bifida patients: predictive factors and management.

A retrospective review of 209 children with spina bifida was performed to determine predictive factors for the development of hydronephrotic changes and to assess the outcome of management. Renal sonography demonstrated hydronephrosis in 100 cases (48%). Two risk factors were identified: level of spinal defect and age of the patient. Higher spinal levels carried the greatest risk of hydronephrosis. The high risk age periods were the first 4 months of life, affecting children with high lesions, and the teenage years, affecting those on clean intermittent catheterisation (CIC). Seventy-nine hydronephrotic patients underwent treatment, whereas for 21 there was improvement in the sonographic appearance without intervention. CIC with or without anticholinergic pharmacotherapy was the most common treatment (58%), but often a combination of modalities was required to achieve improvement. The final result of all treatments was deemed satisfactory in 82% of cases. Renal sonography was a useful screening tool to detect upper tract changes in spina bifida patients.