MAGNETIC-RESONANCE-IMAGING IN CHILDREN WITH VOIDING DYSFUNCTION - IS IT INDICATED

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.