Role of magnetic resonance imaging in children with voiding dysfunction: retrospective analysis of 81 patients.

摘要

OBJECTIVES: To investigate the role of magnetic resonance imaging (MRI) in children with voiding dysfunction and a normal neuro-orthopedic assessment. The differential diagnosis of neurogenic and non-neurogenic voiding dysfunction, particularly in children with occult neurogenic pathologic findings without a clinically demonstrable neurologic defect, is a commonly encountered problem. METHODS: Eighty-one children with voiding dysfunction, including a history of diurnal incontinence, frequency, urgency, urge incontinence, incomplete bladder emptying, recurrent urinary tract infection, and persistent vesicoureteral reflux, constituted our study group. A detailed neuro-orthopedic evaluation was performed in all patients. The urologic evaluation consisted of a detailed history (including bowel function disturbances), renal sonography or excretory urography, spinal x-ray, urinalysis and culture, voiding cystourethrography, and multichannel water cystometry. In all cases, lumbosacral spinal axial and sagittal T1- and T2-weighted MRI performed with a 1.5-Tesla surface coil was reviewed by one neuroradiologist. RESULTS: MRI revealed pathologic findings in 17 (38.6%) of 44 patients who had voiding dysfunction and a normal neuro-orthopedic assessment. All these patients underwent early surgical intervention in our pediatric neurosurgery department. In the postoperative period, objective and/or subjective improvement in voiding symptoms within short (6 months) and long (14 months) periods was observed in 8 (47.0%) and 5 (29.4%) patients, respectively. Ten (58.8%) of those 17 patients had a history of voiding dysfunction refractory to conservative management. CONCLUSIONS: Our results revealed that MRI of the lower spinal cord is a valuable tool in the diagnosis of occult spinal cord disorders, especially in patients with voiding dysfunction refractory to conservative management strategies and normal neurologic and orthopedic assessments.