Comprehensive analysis of the clinical and urodynamic outcomes of secondary tethered spinal cord before and after spinal cord untethering

Alzahrani, Ahmad; Alsowayan, Ossamah; Farmer, Jean‐Pierre; Capolicchio, John-Paul; Jednak, Roman; El‐Sherbiny, Mohamed

doi:10.1016/j.jpurol.2015.08.011

Cited by 13 publications

(9 citation statements)

References 13 publications

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“…26,27 This was indicated to be the underlying reason in a recent report. 28 In addition, the current study would like to highlight the benefit of early detection by multidisciplinary collaboration. Thus, the reason that 88% of patients had urological deterioration may be attributable to the active participation of urologists in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical and urodynamic features of secondary tethered cord syndrome: How can they be found longitudinally?

Lee

Jung

et al. 2021

Neurourology and Urodynamics

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Secondary tethered cord syndrome (TCS) can be diagnosed with signs of progressive deterioration in urological or neuro-orthopedic systems following primary untethering surgery. Though urological deterioration is a common secondary TCS manifestation, a paucity of diagnostic criteria makes diagnoses challenging. A detailed description of urological deterioration may help diagnose secondary TCS. Thus, the clinical and urodynamic features of the current secondary TCS cases were described. Materials and Methods: Fifty-one patients who had undergone reuntethering for secondary TCS experienced improvement or stabilization of progressive problems. Moreover, their clinical and videourodynamic changes were longitudinally described.Results: Loss of postoperative spontaneous voiding was the first urological secondary TCS sign for those who could void spontaneously. Urological problems mostly occurred during elementary school (6-12 years). Major urological presentations were recalcitrant urinary tract infection or urinary incontinence. Follow-up videourodynamic studies revealed typical changes, from acontractile bladder to overactive and low-complaint bladders. While detrusor overactivity did not always occur during the progression, detrusor sphincter dyssynergia was always present in all patients with urological deterioration. All patients postoperatively showed significant urodynamic improvement regardless of preoperative bladder dysfunction. This included four cases of restoring spontaneous voiding. Nine patients experienced newly appearing nonprogressive neuro-orthopedic complications despite their urological improvement. Conclusions: Urological deterioration should prompt secondary TCS suspicion, and changes in clinical patterns and videourodynamic studies helped diagnose it. However, reuntethering can effectively address urological problems at the cost of some neuro-orthopedic functions in some patients.

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Section: Discussionmentioning

confidence: 99%

Clinical and urodynamic features of secondary tethered cord syndrome: How can they be found longitudinally?

Lee

Jung

et al. 2021

Neurourology and Urodynamics

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“…Secondary TSC occurs in 3–30% of patients with a history of spinal cord dysraphism repair. The symptoms of TSC include back pain, leg weakness, foot deformity, and lower urinary tract dysfunction such as urinary incontinence or retention [ 6 ]. It is often difficult to diagnose secondary TSC in patients with a prior history of spinal cord dysraphism repair, especially if neurological symptoms are not evident and there is no typical urological dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Urodynamic evaluations are important for diagnosis and subsequent management, because the urinary symptoms and urodynamic parameters may not always match [ 7 ]. Although several reports [ 6 , 8 ] have noted that lower urinary tract symptoms and urodynamic parameters improve by untethering surgery for secondary TSC, these were retrospective studies with a small number of patients, and some patients had inadequate improvement in low bladder compliance on UDS; thus, the level of evidence can be considered weak. The patient in the current report is in follow-up with the neurosurgeon and undergoes synsacrum MRI scans regularly; however, she and her parents have declined untethering surgery, as she has no symptoms, and untethering surgery is not a riskless procedure.…”

Section: Discussionmentioning

confidence: 99%

Urodynamic effectiveness of a beta-3 adrenoreceptor agonist (vibegron) for a pediatric patient with anticholinergic-resistant neurogenic detrusor overactivity: a case report

et al. 2021

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Background Myelomeningocele, which causes a neurogenic bladder, is usually treated with anticholinergics in children with neurogenic detrusor overactivity (NDO); however, anticholinergics cause side effects such as dry mouth, constipation, attention deficit, and inadequate reduction in detrusor leak point pressure. Vibegron, a novel selective beta-3 adrenoreceptor agonist, is a well-established alternative to anticholinergics in adults with an overactive bladder. It remains unknown whether this agent can be used for pediatric patients. We report the case of a girl with anticholinergic-resistant NDO due to tethered cord syndrome after myelomeningocele repair, who was treated with vibegron. Case presentation A 4-year-old Filipino girl had increased frequency of daytime urinary incontinence and foul-smelling urine since the age of 3. Clinical examination revealed constipation, and urinalysis revealed bacteriuria. Voiding cystourethrography revealed an enlarged and trabeculated bladder without vesicoureteral reflux. On the urodynamic study (UDS), she was found to have detrusor overactivity (DO) and low bladder compliance. She could not void and was diagnosed with overflow incontinence. Clean intermittent catheterization (CIC) and orally administered propiverine (0.8 mg/kg/day) were initiated, and urinary incontinence was resolved. She underwent a UDS annually; the UDS at 6 years of age still revealed DO and low bladder compliance in spite of receiving propiverine. The treatment was switched from propiverine to vibegron (1.4 mg/kg/day). On the UDS after a 5-week treatment schedule of vibegron, the DO disappeared and the bladder compliance improved. CIC and orally administered vibegron have been continued for 7 months so far, and she has had no urinary tract infection with no drug-related adverse events. Conclusions Vibegron was effective and well tolerated in the treatment of a pediatric patient with NDO. Vibegron improved the urodynamic parameters for anticholinergic-resistant neurogenic bladder. This agent can be a beneficial and preferable alternative therapeutic agent to anticholinergics in patients with anticholinergic-resistant NDO.

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“…Preoperative detrusor overactivity, which was considered to be the most significant indicator for the early diagnosis of retethering, was improved by 75% after surgery. According to Alzahrani et al 4) , UDS parameters that revealed postoperative improvement most were intravesical pressure at total cystometric bladder capacity and bladder compliance.…”

Section: Bladder Functionmentioning

confidence: 99%

Retethering : A Neurosurgical Viewpoint

Lee

Kim

Park

et al. 2020

J Korean Neurosurg Soc

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During the follow-up period after surgery for spinal dysraphism, a certain portion of patients show neurological deterioration and its secondary phenomena, such as motor, sensory or sphincter changes, foot and spinal deformities, pain, and spasticity. These clinical manifestations are caused by tethering effects on the neural structures at the site of previous operation. The widespread recognition of retethering drew the attention of medical professionals of various specialties because of its incidence, which is not low when surveillance is adequate, and its progressive nature. This article reviews the literature on the incidence and timing of deterioration, predisposing factors for retethering, clinical manifestations, diagnosis, surgical treatment and its complications, clinical outcomes, prognostic factors after retethering surgery and preventive measures of retethering. Current practice and opinions of Seoul National University Children's Hospital team were added in some parts. The literature shows a wide range of data regarding the incidence, rate and degree of surgical complications and long-term outcomes. The method of prevention is still one of the main topics of this entity. Although alternatives such as spinal column shortening were introduced, re-untethering by conventional surgical methods remains the current main management tool. Re-untethering surgery is a much more difficult task than primary untethering surgery. Updated publications include strong skepticism on re-untethering surgery in a certain group of patients, though it is from a minority of research groups. For all of the abovementioned reasons, new information and ideas on the early diagnosis, treatment and prevention of retethering are critically necessary in this era.

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Comprehensive analysis of the clinical and urodynamic outcomes of secondary tethered spinal cord before and after spinal cord untethering

Cited by 13 publications

References 13 publications

Clinical and urodynamic features of secondary tethered cord syndrome: How can they be found longitudinally?

Clinical and urodynamic features of secondary tethered cord syndrome: How can they be found longitudinally?

Urodynamic effectiveness of a beta-3 adrenoreceptor agonist (vibegron) for a pediatric patient with anticholinergic-resistant neurogenic detrusor overactivity: a case report

Retethering : A Neurosurgical Viewpoint

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