Fernández-Ibieta M, Rojas Ticona J, Villamil V, Guirao Piñera M J, López García A, Zambudio Carmona G
Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
Actas Urol Esp. 2017 Nov;41(9):596-601. doi: 10.1016/j.acuro.2017.01.002. Epub 2017 Mar 31.
In the historical series, the diagnostic yield of lumbosacral magnetic resonance imaging to rule out occult spinal dysraphism (or occult myelodysplasia), requested by paediatric urology, ranged from 2% to 15%. The aim of this study was to define our cost-effectiveness in children with urinary symptoms and to define endpoints that increase the possibility of finding occult spinal dysraphism.
A screening was conducted on patients with urinary dysfunction for whom an magnetic resonance imaging was requested by the paediatric urology clinic, for persistent symptoms after treatment, voiding dysfunction or other clinical or urodynamic findings. We analysed clinical (UTI, daytime leaks, enuresis, voiding dysfunction, urgency, renal ultrasonography, lumbosacral radiography, history of acute urine retention, skin stigma and myalgia) and urodynamic endpoints (hyperactivity or areflexia, voiding dysfunction, interrupted pattern, accommodation value and maximum flow). A univariate analysis was conducted with SPSS 20.0.
We analysed 21 patients during the period 2011-2015. The median age was 6 years (3-10). Three patients (14.3%) had occult spinal dysraphism: one spinal lipoma, one filum lipomatosus and one caudal regression syndrome with channel stenosis. The endpoints with statistically significant differences were the myalgias and the history of acute urine retention (66.7% vs. 5.6%, P=.04; OR= 34; 95%CI: 1.5-781 for both endpoints).
The diagnostic yield of magnetic resonance imaging requested for children with urinary dysfunctions without skin stigma or neuro-orthopaedic abnormalities is low, although nonnegligible. In this group, the patients with a history of acute urine retention and muscle pain (pain, «cramps») can experience a greater diagnostic yield or positive predictive value.
在历史系列研究中，儿科泌尿外科要求进行腰骶部磁共振成像以排除隐匿性脊柱裂（或隐匿性脊髓发育不良）的诊断率为2%至15%。本研究的目的是确定我们对有泌尿系统症状儿童的成本效益，并确定可增加发现隐匿性脊柱裂可能性的终点指标。
对儿科泌尿外科诊所要求进行磁共振成像检查的泌尿系统功能障碍患者进行筛查，这些患者存在治疗后持续症状、排尿功能障碍或其他临床或尿动力学检查结果。我们分析了临床终点指标（尿路感染、日间漏尿、遗尿、排尿功能障碍、尿急、肾脏超声检查、腰骶部X线摄影、急性尿潴留病史、皮肤体征和肌痛）和尿动力学终点指标（活动亢进或无反射、排尿功能障碍、间断模式、顺应值和最大尿流率）。使用SPSS 20.0进行单因素分析。
我们在2011年至2015年期间分析了21例患者。中位年龄为6岁（3至10岁）。3例患者（14.3%）患有隐匿性脊柱裂：1例为脊髓脂肪瘤，1例为脂肪性终丝，1例为伴有通道狭窄的尾椎退化综合征。具有统计学显著差异的终点指标是肌痛和急性尿潴留病史（66.7%对5.6%，P = 0.04；两个终点指标的OR = 34；95%CI：1.5至781）。
对于无皮肤体征或神经骨科异常的泌尿系统功能障碍儿童，磁共振成像的诊断率较低，尽管不可忽视。在这组患者中，有急性尿潴留病史和肌肉疼痛（疼痛、“痉挛”）的患者可能有更高的诊断率或阳性预测值。
