Abbreviations & Acronyms CAP = continuous antibiotic prophylaxis EBC = expected bladder capacity eGFR = estimated glomerular filtration rate f-UTI = febrile urinary tract infection KTx = kidney transplantation MBC = maximum bladder capacity UTI = urinary tract infection VCUG = voiding cystourethrography VUR = vesicoureteral reflux

Introduction) In tethered cord syndrome, the lower end of the spinal cord is moored to the caudal tissue, causing various neuropathies. Bladder dysfunction often appears early. We herein evaluated children with daytime urinary incontinence in whom tethered cord syndrome was eventually diagnosed.(Method) Eighteen children (9 males and 9 females) with daytime urinary incontinence were enrolled between March 2011 and October 2017. The causes of their urinary incontinence were investigated using spinal MRI and changes in clinical symptoms before and after untethering surgery.(Results) The average age at the first visit was 6.3 years (range: 4-9 years). Urodynamic testing and a voiding cystourethrogram (VCUG) were performed in all cases of refractory daytime incontinence, and all patients with abnormal findings on either test underwent spinal MRI. The diagnosis based on spinal MRI findings was filum lipoma in eight, occult tethered cord syndrome in four, low set conus in four, conus lipoma in one, and sacral meningeal cyst in one, patient. The average observation period after untethering surgery was 66.3 months (range: 22-116 months). All the patients achieved a cure postoperatively. Four patients were treated for nocturnal enuresis by oral medication, and three patients required urological management via clean, intermittent catheterization.(Conclusions) When treating children with daytime continence, one should consider the possibility of tethered cord syndrome, the diagnosis of which can be aided by urodynamic assessment of bladder function.

We aimed to investigate the changes in urodynamics and voiding cystourethrogram parameters on pre-and post-untethering surgery in patients aged under 2 years with filum lipoma. Methods: Sixty-two patients were enrolled in this study. The changes in urodynamics and voiding cystourethrogram parameters were compared before untethering surgery and 6 months after untethering surgery. These parameters were bladder volume, bladder deformity, vesicoureteral reflux during voiding cystourethrogram, detrusor overactivity, bladder compliance, and post-void residual volume in urodynamics. Results: Bladder volume during voiding cystourethrogram and bladder compliance increased significantly from 89.8 AE 49.5 mL to 114.5 AE 50.5 mL (P = 0.0069) and 10.2 AE 6.2 mL/mmH 2 O to 17.0 AE 13.3 mL/mmH 2 O (P = 0.0008), respectively, at 6-month follow-up. Six patients required combination management with clean intermittent catheterization at 25.1 AE 8.2 months (14.3 AE 6.5-months follow-up) because of elevated post-void residual volumes. Conclusions: According to voiding cystourethrogram results, bladder function and urodynamics in patients with filum lipoma significantly improved after untethering surgery. Non-invasive assessment based on measurements of post-void residual should be considered as a postoperative follow-up method.

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