Aims of study:
in this retrospective study we evaluated whether there (A) is there a difference in the outcome in regard to upper urinary tract preservation and the achievement of continence among children whom we followed since birth or since early childhood and in those who were referred to us after 2 years of age, and (B) if there is a difference in regard to the necessity of operative treatment vs. conservative treatment between these groups.

Methods:
in 163 patients, 71 (43 %) females and 92 (57 %) males, mean age upon the last control 19 yrs., mean observation time 12 yrs., the initial findings and the findings upon the last check-up were compared. For this retrospective study the patients were categorized as follows: (I) first urological investigation/treatment after birth up to 2 years, (II) between 3 and 10 years, (III) after 10 years of age; patients in groups II and III were referred from elsewhere. Evaluation of the upper urinary tract comprised renal isotope-studies, an IVP and/or ultrasound study, in regard to continence/incontinence patients were categorized in continent (dry day and night), continent during day only, "socially dry" (dry periodes more than 3 hours) and incontinent (dry periodes less than 3 hours).

Results:
A) Upper urinary tract: initial findings normal, in (I) 91 %, in (II) 80 %, in (III) 82 %; normal during the last follow-up, in (I) 100 %, in (II) 86 %, in (III) 95 %; operative treatment to achieve the results was needed in (I) in 16 %, in (II) in 34 %, in (III) in 59 %.

B) Continence/incontinence: of 123 pat.s suitable for this evaluation 67 (37 females, 30 males; 54 %) were continent, 4 (1 female, 3 males; 3 %) were continent during the day, 22 (11 females, 11 males; 17 %) achieved the status of "socially dry" and 31 (7 females, 24 males; 26 %) remained incontinent; in 50 % continence was achieved by conservative treatment only, in the other 50 % operative treatment was needed; in 28/34 a Scott-Sphincter was implanted, in 14/28 together with augmentation cystoplasty.

Conclusions:
Early urological management, if possible starting directly after birth, as it is usually done in spinal cord injured patients, is the best guarantee for preservation of a normal upper urinary tract (100 % in group I), moreover it lowers the need for operative treatment. In 74 % either continence or the status of "socially dry" could be achieved, half of the patients with conservative treatment only, in the other half with the help of operative treatment by implantation of a Scott-sphincter, partly in combination with augmentation-cystoplasty.