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Vol. 41. Issue 9.
Pages 596-601 (November 2017)
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Vol. 41. Issue 9.
Pages 596-601 (November 2017)
Casuistry
DOI: 10.1016/j.acuroe.2017.08.002
Diagnostic yield of lumbosacral magnetic resonance imaging requested by pediatric urology consultations
Rentabilidad diagnóstica de la resonancia magnética lumbosacra solicitada desde las consultas de urología pediátrica
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M. Fernández-Ibietaa,
Corresponding author
mfndezibieta@hotmail.com

Corresponding author.
, J. Rojas Ticonaa, V. Villamila, M.J. Guirao Piñeraa, A. López Garcíab, G. Zambudio Carmonaa
a Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
b Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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Table 1. Scheme of the clinical and urodynamic variables studied, and the prevalence of each one according to the group of patients: with occult myelodysplasia (or occult spinal dysraphism), pathological MRI, or without it (normal MRI).
Abstract
Objectives

In the historical series, the diagnostic yield of lumbosacral magnetic resonance imaging to rule out occult spinal dysraphism (or occult myelodysplasia), requested by pediatric urology, ranged from 2% to 15%. The aim of this study was to define our cost-effectiveness in children with urinary symptoms and to define endpoints that increase the possibility of finding occult spinal dysraphism.

Patients and methods

A screening was conducted on patients with urinary dysfunction for whom an magnetic resonance imaging was requested by the pediatric urology clinic, for persistent symptoms after treatment, voiding dysfunction or other clinical or urodynamic findings. We analyzed clinical (UTI, daytime leaks, enuresis, voiding dysfunction, urgency, renal ultrasonography, lumbosacral radiography, history of acute urine retention, skin stigma and myalgia) and urodynamic endpoints (hyperactivity or areflexia, voiding dysfunction, interrupted pattern, accommodation value and maximum flow). A univariate analysis was conducted with SPSS 20.0.

Results

We analyzed 21 patients during the period 2011–2015. The median age was 6 years (3–10). Three patients (14.3%) had occult spinal dysraphism: one spinal lipoma, one filum lipomatosus and one caudal regression syndrome with channel stenosis. The endpoints with statistically significant differences were the myalgias and the history of acute urine retention (66.7% vs. 5.6%, p=0.04; OR= 34; 95% CI: 1.5–781 for both endpoints).

Conclusions

The diagnostic yield of magnetic resonance imaging requested for children with urinary dysfunctions without skin stigma or neuro-orthopedic abnormalities is low, although nonnegligible. In this group, the patients with a history of acute urine retention and muscle pain (pain, “cramps”) can experience a greater diagnostic yield or positive predictive value.

Keywords:
Lower urinary tract dysfunction
Spina bifida occulta
Myelodysplasia
Magnetic resonance
Occult spinal dysraphism
Resumen
Objetivos

En series históricas, la rentabilidad diagnóstica de la resonancia magnética lumbosacra para descartar disrafismo espinal oculto (o mielodisplasia oculta), solicitada desde urología pediátrica oscila entre el 2 y 15%. El objetivo del estudio es definir nuestra rentabilidad en niños con síntomas miccionales, y definir variables que aumenten la posibilidad de encontrar disrafismo espinal oculto.

Pacientes y métodos

Selección de pacientes con disfunciones miccionales a los que se solicitó resonancia magnética desde las consultas de urología pediátrica, por persistencia de síntomas tras tratamiento, disfunción de vaciado, o por otros hallazgos clínicos o urodinámicos. Se analizaron variables clínicas (ITU, fugas diurnas, enuresis, disfunción de vaciado, urgencia, ecografía renal, radiografía lumbosacra, antecedentes de retención aguda de orina, estigmas cutáneos, mialgias) y urodinámicas (hiperactividad o arreflexia, micción disfuncional, patrón interrumpido, valor de acomodación y flujo máximo). Análisis univariante con SPSS 20.0.

Resultados

Analizamos a 21 pacientes en el periodo 2011-2015. Mediana de edad: 6 años (3-10). Tres pacientes (14,3%) presentaron disrafismo espinal oculto: un lipoma raquídeo, un filum lipomatoso y un síndrome de regresión caudal con estenosis de canal. Las variables con diferencia estadísticamente significativa fueron las mialgias y el antecedente de retención aguda de orina (66,7 vs. 5,6%; p=0,04; OR=34; IC95%: 1,5-781 para ambas variables).

Conclusiones

La rentabilidad diagnóstica de la resonancia magnética solicitada a niños con disfunciones miccionales sin estigmas cutáneos ni alteraciones neuroortopédicas es baja, aunque no desdeñable. En este grupo, los pacientes con antecedentes de retención aguda de orina y/dolor muscular (dolor, «calambres») pueden presentar una rentabilidad diagnóstica o valor predictivo positivo mayor.

Palabras clave:
Disfunción del tracto urinario inferior
Espina bífida oculta
Mielodisplasia
Resonancia magnética
Disrafismo espinal oculto

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