Urodynamic testing: Is it a useful tool in the management of children with cutaneous stigmata of occult spinal dysraphism?
Lavallée LT, Leonard MP, Dubois C, Guerra LA; Journal of Urology (Sep 2012)
Source: J Urol
PURPOSE: Lumbar cutaneous stigmata in infants may be associated with occult spinal dysraphism and often trigger urologic 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.
METHODS: A historical cohort of children with cutaneous stigmata of spinal dysraphism referred to the Children's Hospital of Eastern Ontario from 2002-2010 was reviewed. Patient characteristics, imaging, urodynamic studies, and neurosurgical interventions were reviewed. Analysis was performed assessing the association of urodynamic testing and imaging studies with neurosurgical intervention.
RESULTS: 123 patients were included in this study. 91% (112/123) of the population consisted of non-toilet trained infants (median age 11 months, IQR 6.5, 15.5). 19% (23/123) of patients had abnormal urodynamics, 85% (99/116) had abnormal spinal MRI's, and 96% (98/102) had abnormal spinal ultrasounds. 33% (40/121) of patients underwent surgery for tethered cord release.
A significant association between abnormal urodynamics and neurosurgical intervention was found (p = 0.002). Abnormal spine MRI 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.
CONCLUSION: 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 the determination of the need for surgical intervention in this population.