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High Prevalence of Dysplastic Development of Sacral Vertebral Arches in Pediatric Enuresis
Hideo Ozawa1, Takakuki Shibano2, Isao Tanaka2
1Department of Urology, Mizushima Central Hospital, Kurashiki, Japan.
Insights
Children with enuresis show a higher prevalence of unfused sacral arches compared to controls. This suggests sacral vertebral arch dysplasia may contribute to the development of enuresis in pediatric patients.
Area of Science:
- Pediatric Urology
- Radiology
- Developmental Biology
Background:
- Enuresis, or bedwetting, affects many children and can have various underlying causes.
- Sacral vertebral development is crucial for lower urinary tract function.
- Previous research has not extensively compared sacral bone development in children with and without enuresis.
Purpose of the Study:
- To compare three-dimensional computed tomography (3D-CT) imaging of sacrococcygeal bones in pediatric patients with enuresis and a control group.
- To investigate potential differences in sacral arch fusion patterns between these two groups.
Main Methods:
- 3D-CT scans of the sacrococcygeal region were obtained for 47 children with primary enuresis and 138 controls.
- The presence or absence of unfused sacral arches (L4-S3) was assessed in both groups.
- Age- and sex-matched cohorts were compared to evaluate sacral arch fusion.
Main Results:
- Nearly all children with enuresis exhibited dysplastic sacral arches (lack of fusion at S1-3).
- In age- and sex-matched groups (5-13 years), only 3% of enuresis patients had fully fused sacral arches, versus 63% in controls (P<0.0001).
- Sacral arch fusion rates varied by age, with younger children generally showing more unfused arches.
Conclusions:
- Sacral vertebral arches typically fuse by age 10.
- Children with enuresis demonstrate a significantly higher prevalence of unfused sacral arches.
- Sacral vertebral arch dysplasia may play a pathological role in the development of pediatric enuresis.
Purpose:
This is the first report to compare 3-dimensional computed tomography (3D-CT) images between pediatric patients with enuresis and children without lower urinary tract symptoms who underwent pelvic CT for other reasons.
Methods:
Forty-seven children (33 boys and 14 girls) with primary enuresis underwent 3D-CT of sacrococcygeal bones. The control group consisted of 138 children (78 boys and 60 girls) who underwent pelvic CT for other reasons. First, we determined the presence or absence of unfused sacral arches at the L4-S3 levels in both cohorts. Subsequently, we compared the fusion of sacral arches in age- and sex-matched children from these 2 groups.
Results:
Dysplastic sacral arches, characterized by lack of fusion at 1 or more levels of the S1-3 arches, were observed in nearly all patients in the enuresis group. In the control group (n=138), 54 of 79 children over 10 years old (68%) exhibited fused sacral arches at 3 S1-3 levels. All 11 control children under 4 years old displayed at least 2 unfused sacral arches at the S1-3 levels. In a comparative study of age- and sex-matched patients with enuresis and control children aged 5 to 13 years (n=32 for each group, with 21 boys and 11 girls; mean age, 8.0±2.2 years [range, 5-13 years]), only 1 patient (3%) in the enuresis group exhibited fusion of all S1-3 arches. In contrast, 20 of 32 control group participants (63%) had 3 fused sacral arches (P<0.0001).
Conclusion:
Sacral vertebral arches typically fuse by the age of 10 years. However, in this study, children with enuresis exhibited a significantly elevated prevalence of unfused sacral arches, suggesting that dysplastic development of sacral vertebral arches may play a pathological role in enuresis.
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