Urodynamic Testing—Is it a Useful Tool in the Management of Children with Cutaneous Stigmata of Occult Spinal Dysraphism?

Abstract

Lumbar cutaneous stigmata in infants may be associated with occult spinal dysraphism and often prompt urological 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. We reviewed a historical cohort of children with cutaneous stigmata of spinal dysraphism referred to our hospital from 2002 to 2010. We evaluated patient characteristics, imaging, urodynamic studies and neurosurgical interventions. We analyzed the association between urodynamic testing and imaging studies, and neurosurgical intervention. We retrospectively studied 123 patients with a median age of 11 months (IQR 6.5-15.5), including 112 nontoilet trained infants (91%). Of the patients 19% (23 of 123) had abnormal urodynamics, 85% (99 of 116) had abnormal spinal magnetic resonance imaging and 96% (98 of 102) had an abnormal spinal ultrasound. Tethered cord release was performed in 40 of 121 patients (33%). A significant association was found between abnormal urodynamics and neurosurgical intervention (p = 0.002). Abnormal spinal magnetic resonance imaging 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. 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 determining the need for surgical intervention in this population.