Does Surgical Release of Secondary Spinal Cord Tethering Improve the Prognosis of Neurogenic Bladder in Children With Myelomeningocele?

Abstract

Secondary tethering of the spinal cord is a major risk factor for urological and neurological deterioration in children with myelomeningocele. Close urological surveillance remains the most valuable tool in the early diagnosis. Our study shows that secondary untethering surgery may significantly improve urological outcome.

Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

“…41,42 Most of our patients were submitted to tethered cord release during periods of growth. However, as observed in other studies, 43 secondary tethering of the spinal cord can occur up to 15 years of age. It is now recognized that tethered cord syndrome recurs, 12,41,44,45 which was observed in our study.…”

Is 40 cm H2O detrusor leak point pressure cut‐off reliable for upper urinary tract protection in children with myelodysplasia?

“…We compared the incidence of FUTI, utilization of clean intermittent catheterization (CIC), timing of the primary neurosurgical repair, secondary tethering of the spinal cord (STSC), antimuscarinic treatment, antibiotic prophylaxis, and urodynamic findings between the groups at the age of 3. The decision for a secondary untethering surgery was driven by a neuro‐orthopedic or neuro‐urological damage of the child . We also compared the median of cystometric capacity (ml), DLPP (cmH 2 O), and bladder compliance (ml/cm H 2 O).…”

“…The indication and decision of secondary untethering were mainly driven by a neuro‐orthopedic or neuro‐urological damage of the child during at the time of evaluation. Physical examination, nerve conduction studies, urodynamic findings, and MRI scanning were all used in the decision making for a secondary untethering surgery …”

The effect of intradetrusor botulinum neurotoxin type A on urinary NGF, TGF BETA-1, TIMP-2 levels in children with neurogenic detrusor overactivity due to myelodysplasia

“…An increase or new-onset HN or FUTI prompted an additional VCUG and urodynamic evaluation or fluoroscopic urodynamic evaluation. [3][4][5][6] Antibiotic prophylaxis were initiated after an episode of febrile UTI.…”