Jlp. Salle et al., MAGNETIC-RESONANCE-IMAGING IN CHILDREN WITH VOIDING DYSFUNCTION - IS IT INDICATED, The Journal of urology, 160(3), 1998, pp. 1080-1083
Purpose: We evaluated the role of magnetic resonance imaging (MRI) of
the lumbosacral spinal cord in children with complicated voiding dysfu
nction and normal neuro-orthopedic examination. Materials and Methods:
We reviewed the records of 32 consecutive children with complicated e
nuresis who were referred for neurosurgical evaluation, including thos
e with a history of refractory voiding dysfunction or incontinence ass
ociated with persistent vesicoureteral reflux, encopresis, or associat
ed leg or back pain. Nine patients were excluded from study because of
urethral or anorectal anomalies, or failure to meet the inclusion cri
teria. Eligible for study inclusion were 23 children with a mean age o
f 8.9 years. Complete neurological and orthopedic examinations were no
rmal in all patients except 1 with mild scoliosis and 1 with congenita
l facial palsy. Results: Urodynamic studies revealed instability in 14
cases, hypertonia in 7, hyporeflexia in 2 and detrusor-sphincter dyss
ynergia in 4. Skeletal abnormalities, mostly spina bifida occulta, wer
e detected in 16 of the 23 children (70%). Spinal MRI was normal in 21
patients (91.3%), including 1 with a tethered cord and lipoma associa
ted with a complex skeletal abnormality, and 1 with a nonprogressive,
nonsurgical T7 to T9 syrinx. Only the case of lipoma required neurosur
gical intervention. Conclusions: The value of MRI is limited in childr
en with voiding dysfunction and a normal neuro-orthopedic assessment.
This study should be reserved for patients with associated neuro-ortho
pedic findings or complex skeletal deformity on plain x-ray.