ABSTRACT
In the midportion of the second decade of the twenty-first century there appears to be a paradigm shift in the evaluation and management of newborns with myelodysplasia due to the apparent successful development of prenatal closure of the spinal defect. For practical purposes, however, the urologic management of the newborn with myelodysplasia ideally begins shortly after birth. It is important to evaluate babies this early for a number of reasons. The initial comprehensive assessment begins with an examination of the lower extremities, checking muscle mass, spontaneous movements, deep tendon reflexes, sensation, and anal tone to determine what are the child’s sensory and motor neurologic levels. Urodynamic studies in newborns have revealed unexpected findings when compared to findings in similarly affected older children, reflecting the dynamic nature of the neurologic lesion in myelodysplasia. Initial management is dictated by the findings on urodynamic assessment irrespective of the upper urinary tract appearance on x-ray imaging.
