Kart Mücahit, Doğantekin Engin, Ezer Mehmet, Özkürkçügil Cüneyd
Department of Pediatric Urology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.
Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey.
Int Urol Nephrol. 2025 Mar;57(3):735-740. doi: 10.1007/s11255-024-04249-5. Epub 2024 Oct 23.
This study aims to evaluate the necessity of spinal cord magnetic resonance imaging (MRI) in children with persistent enuresis, specifically those presenting with urodynamically reduced bladder capacity (RBC) and detrusor overactivity (DO), in comparison to children with normal urodynamic findings.
We evaluated 586 children admitted for bedwetting, all of whom received urotherapy and/or pharmacotherapy. Persistent enuresis, lasting for over one year, was identified in 134 patients who were subsequently re-evaluated for occult neurological conditions and recommended for urodynamic studies (UDS). In total, 92 patients provided informed consent and underwent UDS. Of these, 40 patients were divided into two cohorts based on UDS findings. All patients were over 6 years of age and had normal physical examinations. The first cohort consisted of 23 children RBC and DO, while the second cohort included 17 children with normal UDS findings. All participants underwent spinal cord MRI with a 3 Tesla scanner. Urodynamic and MRI results were compared using Fisher's chi-square test.
The median age of the cohort was 11 years, with 26 (65%) of the patients being female. Spinal disorders were identified in 10 patients (25%), with 8 cases of spina bifida without neurological compression and 2 cases of tethered cord. In the RBC + DO cohort, 7 out of 23 patients (30.4%) were found to have spinal disorders, compared to 3 out of 17 patients (17.6%) in the normal UDS cohort, with no statistically significant difference between the groups (p > 0.05).
When evaluating persistent enuresis nocturna, a combination of RBC and DO in children with nocturnal enuresis and daytime symptoms may warrant spinal cord MRI, though with limited cost-effectiveness.
本研究旨在评估脊髓磁共振成像（MRI）在持续性遗尿症儿童中的必要性，特别是那些尿动力学检查显示膀胱容量减少（RBC）和逼尿肌过度活动（DO）的儿童，并与尿动力学检查结果正常的儿童进行比较。
我们评估了586名因尿床入院的儿童，所有儿童均接受了尿疗法和/或药物治疗。在134名持续遗尿症（持续时间超过一年）患者中确定了隐匿性神经疾病，并建议进行尿动力学研究（UDS）。总共有92名患者提供了知情同意并接受了UDS。其中，40名患者根据UDS结果分为两个队列。所有患者年龄均超过6岁，体格检查正常。第一队列由23名RBC和DO儿童组成，而第二队列包括17名UDS结果正常的儿童。所有参与者均使用3特斯拉扫描仪进行脊髓MRI检查。使用Fisher卡方检验比较尿动力学和MRI结果。
该队列的中位年龄为11岁，其中26名（65%）患者为女性。10名患者（25%）被发现患有脊柱疾病，其中8例为无神经压迫的脊柱裂，2例为脊髓栓系。在RBC+DO队列中，23名患者中有7名（30.4%）被发现患有脊柱疾病，而在正常UDS队列的17名患者中有3名（17.6%），两组之间无统计学显著差异（p>0.05）。
在评估持续性夜间遗尿症时，对于有夜间遗尿症和白天症状且合并RBC和DO的儿童，可能需要进行脊髓MRI检查，尽管成本效益有限。
