Pippi Salle J L, Capolicchio G, Houle A M, Vernet O, Jednak R, O'Gorman A M, Montes J L, Farmer J P
Department of Pediatric Urology, Montreal Children's Hospital, McGill University, Quebec, Canada.
J Urol. 1998 Sep;160(3 Pt 2):1080-3. doi: 10.1097/00005392-199809020-00030.
We evaluated the role of magnetic resonance imaging (MRI) of the lumbosacral spinal cord in children with complicated voiding dysfunction and normal neuro-orthopedic examination.
We reviewed the records of 32 consecutive children with complicated enuresis who were referred for neurosurgical evaluation, including those with a history of refractory voiding dysfunction or incontinence associated with persistent vesicoureteral reflux, encopresis, or associated leg or back pain. Nine patients were excluded from study because of urethral or anorectal anomalies, or failure to meet the inclusion criteria. Eligible for study inclusion were 23 children with a mean age of 8.9 years. Complete neurological and orthopedic examinations were normal in all patients except 1 with mild scoliosis and 1 with congenital facial palsy.
Urodynamic studies revealed instability in 14 cases, hypertonia in 7, hyporeflexia in 2 and detrusor-sphincter dyssynergia in 4. Skeletal abnormalities, mostly spina bifida occulta, were detected in 16 of the 23 children (70%). Spinal MRI was normal in 21 patients (91.3%), including 1 with a tethered cord and lipoma associated with a complex skeletal abnormality, and 1 with a nonprogressive, nonsurgical T7 to T9 syrinx. Only the case of lipoma required neurosurgical intervention.
The value of MRI is limited in children with voiding dysfunction and a normal neuro-orthopedic assessment. This study should be reserved for patients with associated neuroorthopedic findings or complex skeletal deformity on plain x-ray.
我们评估了腰骶部脊髓磁共振成像（MRI）在排尿功能障碍复杂且神经骨科检查正常的儿童中的作用。
我们回顾了连续32例因神经外科评估而转诊的复杂性遗尿儿童的记录，包括那些有难治性排尿功能障碍或与持续性膀胱输尿管反流、大便失禁或相关腿部或背部疼痛相关的尿失禁病史的儿童。9例患者因尿道或肛门直肠畸形或不符合纳入标准而被排除在研究之外。符合研究纳入标准的23例儿童平均年龄为8.9岁。除1例轻度脊柱侧弯和1例先天性面瘫外，所有患者的完整神经和骨科检查均正常。
尿动力学研究显示14例不稳定，7例张力亢进，2例反射减退，4例逼尿肌-括约肌协同失调。23例儿童中有16例（70%）检测到骨骼异常，主要是隐性脊柱裂。21例患者（91.3%）的脊柱MRI正常，其中1例脊髓栓系伴脂肪瘤合并复杂骨骼异常，1例T7至T9节段有非进行性、无需手术的脊髓空洞症。只有脂肪瘤病例需要神经外科干预。
MRI对排尿功能障碍且神经骨科评估正常的儿童价值有限。这项研究应仅用于有相关神经骨科发现或X线平片上有复杂骨骼畸形的患者。
