Elsevier

Urology

Volume 68, Issue 3, September 2006, Pages 652-654
Urology

Pediatric urology
Ultrasound imaging of sacral reflexes

https://doi.org/10.1016/j.urology.2006.03.077Get rights and content

Abstract

Objectives

To investigate the reliability of examination of the guarding reflex of the pelvic floor by dynamic perineal ultrasonography in children with bladder dysfunction and in controls.

Methods

A total of 40 patients with nonneurogenic bladder/sphincter dyssynergia, 40 with spina bifida, and 40 controls underwent a dynamic ultrasound examination of the pelvic floor while coughing and while being tapped on the abdominal wall. The reflex action of the puborectal muscle in females, and the combined action of the puborectal muscle and external sphincter muscle in males, were recorded.

Results

Of the 40 patients with nonneurogenic bladder/sphincter dyssynergia, 38 had a normal reflex action of the puborectal muscle during the abdominal tap and 36 had a normal reflex action when coughing. Two of these patients had unexplained underactive bladder syndrome and were using clean intermittent catheterization, and two could not be assessed because of hypermobility of the bladder neck when coughing but had a normal reaction during abdominal tapping. Of the 40 patients with spina bifida, none had puborectal activity during coughing and 5 had some puborectal activity during tapping. Of the 40 controls, 39 had normal reflex activity during both coughing and tapping.

Conclusions

The question of whether a child has nonneurogenic or neuropathic bladder/sphincter dysfunction is often difficult to answer on the basis of urodynamic studies alone. Dynamic perineal ultrasound recording of the S2-S4 reflex arches provides reliable additional information and is noninvasive to the patient.

Section snippets

Material and methods

Perineal ultrasonography in children with suspected lower urinary tract dysfunction is performed with a 7-MHz small parts probe on the urethral meatus in girls and behind the scrotum in boys. Scanning is carried out in the sagittal plane. In girls, static information is obtained on the length and width of the urethra and bladder neck and the filling state of the rectum (Fig. 1). Asking the patient to cough or gently tapping the patient’s abdominal wall can give dynamic information on the

Results

Of the 40 patients with spina bifida, pelvic floor reflex activity was absent in all 25 patients with urodynamically paralyzed sphincters. Of the 15 patients with detrusor/sphincter dyssynergia, reflex activity was absent on coughing in all and present on tapping in 5. Of the 40 patients with NNBSD, reflex activity could be seen on tapping in 38 and reflex activity on coughing was observed in 36. Of the 4 patients without reflex activity on coughing, 2 also had no reflex activity on tapping.

Comment

To the best of our knowledge, this is the first report describing the use of perineal ultrasound examinations for the diagnosis of sacral nerve function. The assessment of the sacral nerves is usually done using electrophysiologic techniques or indirectly during urodynamic studies, but these procedures are invasive.4, 5, 6 To exclude a tethered cord, magnetic resonance imaging is used successfully. Magnetic resonance imaging, however, is much more expensive and requires general anesthesia in

Conclusions

Dynamic perineal ultrasonography appears to be a reliable additional tool in the assessment of sacral neurologic functioning in children with voiding dysfunction.

References (9)

There are more references available in the full text version of this article.

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