Sacral Agenesis- Its Urological Impact and Management

Sacral agenesis is a rare developmental disorder, in which there is absence of part or all of two or more sacral vertebral bodies. It is mostly associated with dysfunction of bowel, bladder and neuromuscular system of lower limbs. Voiding impairment (neurogenic bladder), Vescico-Ureteric Reflux (VUR) together with urinary tract infection contribute to renal injury. Here authors are reporting an 11-year-old female, who was diagnosed to have sacral agenesis with anorectal malformation at the age of six month, leading to anal trans-positioning done at that age, she presented to the Urology Department with acute kidney injury. On evaluation, she was found to have overactive bladder with increased bladder capacity and bilateral grade 5 VUR. After recovery from acute kidney injury with conservative management and catherization, she was discharged with the advice of clean intermittent catheterization and anticholinergic drug. On follow-up, she was doing well. Early diagnosis and long term follow-up is required in the patients having sacral agenesis with multidisciplinary team including urologist, as these patients may develop lower urinary tract symptoms, VUR and kidney injury at any time in their growth period.