Investigation of daytime wetting: when is spinal cord imaging indicated?

Area of Science:

• Pediatric Urology
• Neurourology
• Diagnostic Imaging

Background:

• Daytime wetting in children often stems from detrusor instability, but a subset presents with neuropathic vesicourethral dysfunction.
• Closed spina bifida is a primary cause of neuropathic dysfunction, potentially indicated by subtle cutaneous, neuro-orthopaedic, or spinal abnormalities.
• Magnetic resonance imaging (MRI) of the spine is the definitive tool for identifying spinal cord abnormalities.

Purpose of the Study:

• To establish clear indications for spinal MRI in pediatric patients experiencing voiding dysfunction.
• To evaluate the necessity of spinal MRI in children with daytime wetting and specific clinical signs.

Main Methods:

• A retrospective analysis was conducted on children with voiding dysfunction referred for spinal MRI.
• Data from clinical records and investigations, including urodynamic studies and MRI results, were reviewed.
• The study period spanned from April 1998 to April 2000 at Guy's Hospital neurourology clinic.

Main Results:

• The study included 48 children with a median age of 9.1 years.
• Closed spina bifida was diagnosed in five children, with four exhibiting neuropathic vesicourethral dysfunction confirmed by urodynamics.
• Impaired bladder sensation and incomplete bladder emptying were significantly more prevalent in children with spinal cord abnormalities compared to those with normal MRI findings.

Conclusions:

• Spinal cord imaging via MRI should be considered for children with daytime wetting exhibiting impaired bladder sensation or poor bladder emptying.
• The indication for spinal MRI remains valid even when external signs like neuro-orthopaedic, cutaneous, or lumbosacral spine x-ray abnormalities are absent.
• This approach can identify occult spinal abnormalities contributing to voiding dysfunction.