The value of sacral skin lesions in predicting occult spinal dysraphism in children with voiding dysfunction and normal neurological examination.
OBJECTIVE
The role of magnetic resonance imaging (MRI) in detecting occult spinal dysraphism (OSD) in children with voiding dysfunction and a normal neurological examination is still under debate. The aim of this study was to assess the correlation of sacral skin lesions with OSD detected on MRI, in a population of children with resistant lower urinary tract symptoms (LUTS).


METHODS
A total of 114 children over 5 years of age with urinary tract infection (UTI) and/or LUTS and normal neurological examination were enrolled. All children underwent sacral neurological examination, urine analysis and cultures, renal/bladder ultrasound, voiding cystourethrogram and urodynamic examination. After a treatment period of 6 months, the patients were re-evaluated and spinal MRI was performed in 61 with ongoing LUTS or UTI.


RESULTS
Nineteen of 61 children (31%) had cutaneous stigmas. MRI detected spinal abnormality in 2/42 children with a normal sacral examination in comparison to 7/19 children with an abnormal sacral finding (Chi-squared test, P < 0.005). The sensitivity and specificity of an abnormal sacral finding in predicting MRI abnormality were 0.76 and 0.77, respectively. Urodynamic parameters did not predict an abnormal spinal MRI.


CONCLUSIONS
Abnormal sacral findings, but not urodynamic studies, are strong predictors of OSD. A normal sacral examination does not rule out OSD.
Department of Urology, Division of Pediatric Urology, Marmara University School of Medicine, Marmara University Hospital, Tophanelioglu Cd. 13-15 Altunizade 34662, Istanbul, Turkey. tufan@marmara.edu.tr
Tufan
T
Tarcan
Ilker
I
Tinay
Yusuf
Y
Temiz
Harika
H
Alpay
Memet
M
Ozek
Ferruh
F
Simsek
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000453:epidemiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009436:Neural Tube Defects / Q000175:diagnosis* / Q000453:epidemiology; D009460:Neurologic Examination / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012445:Sacrococcygeal Region; D012868:Skin Abnormalities / Q000175:diagnosis*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000453:epidemiology; D014563:Urodynamics