© 2002 Archives of Disease in Childhood
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Daytime wetting is a common reason for referral to general and community paediatric clinics. Investigations are rarely necessary, beyond excluding urinary tract infection, polyuria, psychological distress and—perhaps—constipation. Such a course of action will miss the few children who have neuropathic vesicourethral dysfunction in association with a spinal cord anomaly. Diagnosis is by MRI of the spine but the indications are not clear. This month we publish a retrospective study of children referred from a tertiary neuro-urology clinic for exclusion of such an anomaly. Forty-eight children were studied, 5 proving positive. Wraige and Borzyskowski from Guy's Hospital, London have used their findings to offer guidance on which children merit imaging, including in their paper a suggested investigative protocol
You should think MRI if daytime wetting is associated with abnormal neurological signs in the lower limbs, an abnormal lumbar spine x ray, lumbosacral birthmarks, or anorectal anomalies. Think twice, but do videourodynamic
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