Location of spina bifida occulta and ultrasonographic bladder abnormalities predict the outcome of treatment for primary nocturnal enuresis in children

Abstract

Objective: We examined whether the existence of spina bifida occulta or ultrasonographic bladder abnormalities was related to the outcome of treatment for primary nocturnal enuresis in children.

Methods: Between April 1996 and September 2005, a total of 77 subjects (53 boys and 24 girls, aged 5-18 years; mean age, 9.9 years) with primary nocturnal enuresis were studied. Plain X-ray films of the spine and ultrasonographic bladder measurements (bladder wall thickness, bladder neck descent and bladder neck opening) were obtained and the correlations with the outcome of treatment using imipramine hydrochloride were assessed.

Results: On plain X-ray films of the spine, spina bifida occulta (lumbar vertebrae in three, lumbosacral vertebrae in 19 and sacral vertebrae in 31) was recognized in 53 children (69%). Ultrasonographic bladder abnormalities were recognized in 40 children (52%). Children with lumbar and lumbosacral spina bifida occulta showed a higher rate of concomitant ultrasonographic bladder abnormalities (P = 0.006) and had a poorer response to treatment (P = 0.041) compared with the children who had sacral spina bifida occulta. Children with ultrasonographic bladder abnormalities had a worse response to treatment (P = 0.005) compared to the children without bladder abnormalities.

Conclusions: The presence of lumbar spina bifida occulta and ultrasonographic bladder abnormalities was related to the outcome of treatment for primary nocturnal enuresis in children, suggesting that spinal radiography and vesical ultrasonography may be useful predictive tests.