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

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 dysfun ction, particularly in children with occult neurogenic pathologic findings without a clinically demonstrable neurologic defect, is a commonly encounte red 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 vesicou reteral reflux, constituted our study group. A detailed neuro-orthopedic ev aluation was performed in all patients. The urologic evaluation consisted o f a detailed history (including bower function disturbances), renal sonogra phy or excretory urography, spinal x-ray, urinalysis and culture, voiding c ystourethrography, and multichannel water cystometry. In all cases, lumbosa cral spinal axial and sagittal T-1- and T-2-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 neurosurge ry department. In the postoperative period, objective and/or subjective imp rovement in voiding symptoms within short (6 months) and long (14 months) p eriods 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 refractor y to conservative management. Conclusions. Our results revealed that MRI of the lower spinal cord is a va luable tool in the diagnosis of occult spinal cord disorders, especially in patients with voiding dysfunction refractory to conservative management st rategies and normal neurologic and orthopedic assessments. UROLOGY 54:157-1 61, 1999. (C) 1999, Elsevier Science Inc.