Does combination of urodynamic reduced bladder capacity and detrusor overactivity warrant spinal cord magnetic resonance imaging in children with persistan enuresis: a prospective study.

Abstract

Purpose: 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.

Methods: 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.

Results: 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).

Conclusion: 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.