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Urodynamic testing--is it a useful tool in the management of children with cutaneous stigmata of occult spinal
L T Lavallée1, M P Leonard, C Dubois
1Department of Surgery, Division of Pediatric Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Abnormal urodynamic testing in infants with spinal dysraphism is linked to needing surgery. This diagnostic tool helps neurosurgeons decide on tethered cord release interventions.
Area of Science:
- Pediatric Urology
- Pediatric Neurosurgery
- Diagnostic Imaging
Background:
- Lumbar cutaneous stigmata in infants can indicate occult spinal dysraphism.
- Urological evaluation, including urodynamic testing, is often pursued for these infants.
- The utility of urodynamic testing in predicting the need for surgical intervention requires further investigation.
Purpose of the Study:
- To determine if urodynamic testing is a useful diagnostic tool in infants presenting with lumbar cutaneous stigmata.
- To evaluate the association between abnormal urodynamic test results and the subsequent need for tethered cord release surgery.
Main Methods:
- A historical cohort of 123 infants with cutaneous stigmata of spinal dysraphism was reviewed.
- Data collected included patient demographics, imaging studies (spinal MRI, spinal and abdominal ultrasounds), urodynamic testing, and neurosurgical interventions.
- Statistical analysis was performed to assess the association between urodynamic findings, imaging results, and the need for tethered cord release.
Main Results:
- 19% of infants had abnormal urodynamic studies, while 85% had abnormal spinal MRIs and 96% had abnormal spinal ultrasounds.
- Tethered cord release was performed in 33% of the patients.
- Abnormal urodynamics showed a significant association with neurosurgical intervention (p = 0.002), as did abnormal spinal MRI (p = 0.05).
Conclusions:
- Abnormal urodynamic studies in infants with cutaneous stigmata are significantly associated with the need for neurosurgical intervention.
- Urodynamic testing serves as a crucial diagnostic modality for neurosurgeons when considering surgical intervention for tethered cord release in this population.
Purpose:
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.
Materials And Methods:
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.
Results:
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.
Conclusions:
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.
