Abstract:

Objective

To explore the correlation between imaging manifestations ，clinical symptoms and efficacy of Nocturnal enuresis （NE） in children with spina bifida occulta （SBO）.

Methods

From July 1， 2020 to June 30， 2023， 48 children diagnosed with NE combined with SBO in the Fifth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed in terms of imaging data，questionnaire survey and urinary diaries， and the clinical data of the included children were analyzed. Two radiologists independently evaluated the SBO classification， grading， and the number of vertebrae involved based on X-ray， and scored the SBO again after an interval of 1 month. The consistency between the two radiologists and within the radiologists was evaluated by Kappa consistency test. The Chi-square test or fisher's exact test was used to explore the correlation between different types， grades， the number of involved vertebrae and the general conditions of children with SBO enuresis， such as gender， age， severity of enuresis，presence or not of overactive bladder， single symptom nocturnal enuresis， and drug treatment response.

Results

1） Among the 48 children， SBO was divided into unilateral type （27 cases）， floating spine type（17 cases） and rostral spine type （4 cases）. In terms of the severity of enuresis， the unilateral type was mainly light and medium， while the floating spine and rostral spine types were predominantly severe， with statistical difference between them （P＜0.05）. In terms of treatment response， rostral spine type had the worst effect，with statistical difference （P＜0.05）. 2） Among the 48 children with SBO， 34 cases had grade Ⅰ， 8 cases had grade Ⅱ， and 6 cases had grade Ⅲ. There were no statistical differences in clinical symptoms and treatment of NE children with different grade SBO （P＞0.05）. 3） Among the 48 children with spina bifida， 27 cases had one vertebral body involvement， 18 cases had two vertebral bodies involvement， and 3 cases had three vertebral bodies involvement. In terms of age， the children with three vertebral bodies involvement were older than the other two groups， with statistical difference （P＜0.05）. In terms of treatment response， the effective rates of one vertebral involvement and two vertebral involvement were all above 85%， while the children with three vertebral involvement did not respond to treatment， and the difference was statistically significant（P＜0.05）.

Conclusion

The clinical manifestation and therapeutic effect of NE children with SBO are different. The floating spine type and rostral spine type are dominantly characterized by severe enuresis， and rostral spine type has the worst therapeutic effect. The more involved the vertebrae， the less effective the treatment. Therefore， holistic and individual evaluation and treatment should be carried out in the diagnosis and treatment of NE children with SBO.

Key words: Spina bifida occulta, Nocturnal enuresis, Children, Clinical features, Correlation