Editing Pediatrics: Neuromuscular Disorders of the Lower Urinary Tract (section)

== Sacral Agenesis ==

* '''Definition of sacral agenesis: absence of part or all of ≥2 lower vertebral bodies'''
* '''Risk factors: maternal diabetes and gestational diabetes'''
* '''Presentation'''
** '''Bimodal presentation; 75% detected in early infancy vs. 25% discovered between 4 and 5 years of age'''
** Because these children have '''normal perineal sensation''' and '''little or no orthopedic deformity''' in the lower extremities the underlying lesion is often overlooked. The only clue, besides a high index of suspicion, is '''flattened buttocks with a low, short gluteal cleft'''
** '''When not detected prenatally or at birth, the diagnosis is often delayed until failed attempts at toilet training''' bring the child to the attention of a physician.
*** '''Presenting urinary symptoms in those aged ≥ 4 include urinary incontinence or constant dribbling''' in 85% '''and recurrent UTI''' in 74%.
* '''Initial investigation includes urodynamics, renal ultrasound, and nuclear cystogram'''
* Long-term follow-up is required