Department of Surgery, Division of Pediatric Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
J Urol. 2013 Feb;189(2):678-83. doi: 10.1016/j.juro.2012.08.203. Epub 2012 Oct 8.
Lumbar cutaneous stigmata in infants may be associated with occult spinal dysraphism and often prompt urological evaluation, including urodynamic testing. We examined whether urodynamic testing is useful in this population by evaluating the association between abnormal urodynamic test results and need for tethered cord release.
We reviewed a historical cohort of children with cutaneous stigmata of spinal dysraphism referred to our hospital from 2002 to 2010. We evaluated patient characteristics, imaging, urodynamic studies and neurosurgical interventions. We analyzed the association between urodynamic testing and imaging studies, and neurosurgical intervention.
We retrospectively studied 123 patients with a median age of 11 months (IQR 6.5-15.5), including 112 nontoilet trained infants (91%). Of the patients 19% (23 of 123) had abnormal urodynamics, 85% (99 of 116) had abnormal spinal magnetic resonance imaging and 96% (98 of 102) had an abnormal spinal ultrasound. Tethered cord release was performed in 40 of 121 patients (33%). A significant association was found between abnormal urodynamics and neurosurgical intervention (p = 0.002). Abnormal spinal magnetic resonance imaging was also significantly associated with operative intervention (p = 0.05). Ultrasound of the spine (p = 1.0), ultrasound of the abdomen/pelvis (p = 0.68), history of urinary tract infections (p = 1.0) and constipation (p = 0.67) were not associated with intervention for tethered cord release.
Abnormal urodynamic studies in infants with cutaneous stigmata of spinal dysraphism are significantly associated with the requirement for neurosurgical intervention. Urodynamics are an important diagnostic modality aiding the neurosurgeon in determining the need for surgical intervention in this population.
婴儿的腰骶部皮肤标志可能与隐性脊柱裂畸形有关，常促使泌尿科进行评估，包括尿动力学检查。我们通过评估异常尿动力学检查结果与脊髓栓系松解术需求之间的关系，来研究该人群中尿动力学检查是否有用。
我们回顾了 2002 年至 2010 年期间我院收治的有脊柱裂畸形皮肤标志的儿童的历史队列。我们评估了患者的特征、影像学、尿动力学研究和神经外科干预。我们分析了尿动力学检查与影像学研究和神经外科干预之间的关联。
我们回顾性研究了 123 例中位年龄为 11 个月（IQR 6.5-15.5）的患者，包括 112 例未经如厕训练的婴儿（91%）。19%（23/123）的患者有异常尿动力学，85%（99/116）的患者有异常脊髓磁共振成像，96%（98/102）的患者有异常脊髓超声。121 例患者中有 40 例（33%）接受了脊髓栓系松解术。异常尿动力学与神经外科干预之间存在显著关联（p = 0.002）。异常脊髓磁共振成像也与手术干预显著相关（p = 0.05）。脊柱超声（p = 1.0）、腹部/骨盆超声（p = 0.68）、尿路感染史（p = 1.0）和便秘（p = 0.67）与脊髓栓系松解术无关。
有脊柱裂畸形皮肤标志的婴儿异常尿动力学研究与神经外科干预的需求显著相关。尿动力学是一种重要的诊断方式，可帮助神经外科医生确定该人群中手术干预的必要性。
