Arikan N, Soygür T, Selçuki M, Erden I, Göğüş O
Department of Urology, Ankara University School of Medicine, Turkey.
Urology. 1999 Jul;54(1):157-60; discussion 160-1. doi: 10.1016/s0090-4295(99)00183-1.
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.
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.
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.
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.
探讨磁共振成像（MRI）在排尿功能障碍且神经 - 骨科评估正常的儿童中的作用。神经源性和非神经源性排尿功能障碍的鉴别诊断，尤其是在隐匿性神经源性病理表现但无临床可证实神经缺陷的儿童中，是一个常见问题。
81例有排尿功能障碍的儿童组成了我们的研究组，这些儿童有日间尿失禁、尿频、尿急、急迫性尿失禁、膀胱排空不全、反复尿路感染和持续性膀胱输尿管反流病史。对所有患者进行了详细的神经 - 骨科评估。泌尿外科评估包括详细病史（包括肠道功能障碍）、肾脏超声或排泄性尿路造影、脊柱X线、尿液分析和培养、排尿性膀胱尿道造影以及多通道水囊膀胱测压。所有病例均由一名神经放射科医生回顾经1.5特斯拉表面线圈进行的腰骶部脊柱轴位和矢状位T1加权及T2加权MRI。
在44例排尿功能障碍且神经 - 骨科评估正常的患者中，MRI发现17例（38.6%）有病理表现。所有这些患者均在我们的小儿神经外科接受了早期手术干预。术后短期内（6个月）和长期内（14个月），分别有8例（47.0%）和5例（29.4%）患者的排尿症状有客观和/或主观改善。这17例患者中有10例（58.8%）有保守治疗无效的排尿功能障碍病史。
我们的结果表明，脊髓下部的MRI是诊断隐匿性脊髓疾病的有价值工具，特别是对于保守治疗策略无效且神经和骨科评估正常的排尿功能障碍患者。
