Long-term urological outcomes of spinal lipoma after prophylactic untethering in infancy: real-world outcomes by lipoma anatomy

Hayashi, Chikara; Kumano, Yohei; Hirokawa, Daisuke; Sato, Hiroki; Yamazaki, Yoji

doi:10.1038/s41393-019-0385-y

Cited by 11 publications

(7 citation statements)

References 21 publications

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“…Therefore, the authors suggested that evidence does not support the prophylactic untethering of complex LMMC types. A recent agecontrolled study by Hayashi et al 15 showed that the transitional LMMC type was associated with an increased need for CIC and urinary incontinence, which is consistent with our study findings. We identified postoperative urinary retention and a T1 UD score greater than or equal to 5 as risk factors for permanent CIC and incontinence.…”

Section: Discussionsupporting

confidence: 93%

“…9 Although many studies have attempted to identify prognostic factors associated with the outcomes of patients with LMMC, [10][11][12][13] the follow-up periods of most studies have been relatively short. The type of LMMC has previously been identified as a prognostic risk factor, 14,15 but the long-term prognosis over time according to the type of LMMC have not been thoroughly studied.…”

Section: Introductionmentioning

confidence: 99%

“…Although many studies have attempted to identify prognostic factors associated with the outcomes of patients with LMMC, 10–13 the follow‐up periods of most studies have been relatively short. The type of LMMC has previously been identified as a prognostic risk factor, 14,15 but the long‐term prognosis over time according to the type of LMMC have not been thoroughly studied. Therefore, we conducted this longitudinal study to identify risk factors associated with permanent CIC and urinary incontinence and assessed changes in bladder function over time, assessed by measuring the urodynamic (UD) score at multiple time points in patients with different types of LMMC.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of factors affecting permanent clean intermittent catheterization and bladder function after primary neurosurgical repair of lipomyelomeningocele

Kim

Han

et al. 2022

Neurourology and Urodynamics

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Aims This study was conducted to identify potential risk factors for permanent clean intermittent catheterization (CIC) and incontinence in patients with lipomyelomeningocele (LMMC) and evaluate how LMMC affects bladder function prognosis, measured by urodynamic (UD) score. Methods This retrospective study analyzed the electronic health records of patients who underwent primary neurosurgical repair for LMMC at a single tertiary referral center between January 2012 and December 2016 and were followed at least 3 years after surgery. Data regarding bladder function were obtained from medical records for multiple time points, including before surgery, after surgery but before hospital discharge, 3 months after surgery, and at outpatient visits during follow‐up. Results This study enrolled 120 patients. At a mean follow‐up of 62.6 ± 13.9 months after primary neurosurgical LMMC repair, 22 (18.3%) patients continued to require CIC for bladder emptying, only 7 (31.8%) of whom maintained bladder continence. A multivariate logistic regression model identified age at the time of surgery and the type of LMMC as significant presurgical prognostic risk factors for permanent CIC. In addition, postoperative urinary retention and a UD score greater than or equal to 5 measured 3 months after surgery were identified as significant postsurgical risk factors for permanent CIC and urinary incontinence. A linear mixed model adjusted for age at the time of surgery showed that patients with a transitional or chaotic LMMC type were more likely to experience gradual bladder function decline than patients with other LMMC types. Conclusions This study identified both presurgical (age at the time of surgery, LMMC type) and postsurgical (postoperative urinary retention, UD score greater than or equal to 5 at 3 months postsurgery) risk factors for permanent CIC and urinary incontinence. In addition, LMMC type was identified as a prognostic risk factor for bladder function decline. These results will enhance the current understanding of bladder function outcomes in patients who undergo surgical treatment for LMMC.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of factors affecting permanent clean intermittent catheterization and bladder function after primary neurosurgical repair of lipomyelomeningocele

Kim

Han

et al. 2022

Neurourology and Urodynamics

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“…The early neuro-urological complication rate following partial resection is approximately 8% [2,18] however, late deterioration in urological function is common. In two recent studies concerning partial resection, CIC was required in 23% [19] and 19% [20] of all cases, increasing to 47% [19] and 54% [20], respectively, if just transitional lipomas were considered. The published literature suggests that once urologic abnormalities are present, they are frequently irreversible, and this has been the basis of one of the most cogent arguments favouring prophylactic surgery.…”

Section: Discussionmentioning

confidence: 99%

Radical resection of lumbosacral lipomas in children: the Great Ormond Street Hospital experience

et al. 2022

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Purpose In 2009, Pang described a radical resection technique for congenital lumbosacral lipomas, with lower long-term symptomatic re-tethering rates compared with partial resections and conservative management, and low surgical morbidity. We adopted this technique in 2011, and aim to describe our first results. Methods In this monocentric retrospective audit, we included dorsal, transitional, chaotic, and caudal-type lumbosacral lipomas. Exclusion criteria were previously operated lipomas, pure filar lipomas, and concomitant major congenital anatomical urogenital/gastrointestinal abnormalities. Neuro-uro-orthopaedic status at presentation and at three months, one year and last postoperative follow-up, intraoperative electrophysiology, and extent of resection were collected. Results From January 2011 to September 2019, 91 patients were operated (median age 2y2m; 63 transitional; 14 caudal; 8 dorsal; 6 chaotic). Preoperatively, 67% were symptomatic. Preoperative and one-year postoperative rates of impaired ambulation (44% to 43%), hypoesthesia (8% to 5%), urodynamic/uroradiological abnormalities (49% to 37%), and foot/ ankle deformities (8% to 5%) were comparable, whilst pain improved (25% to 5%) but catheterisation rates increased (21% to 36%). 23/92 (25%) suffered wound-related complications. 2/91 (2%) developed symptomatic re-tethering requiring second surgery. Mean cord/sac ratio was 0.47. 43% had > 20 mm 3 residual fat, which improved with increasing surgical experience. Conclusion Radical lipoma resection, guided by intraoperative neuromonitoring, with reconstruction of the neural placode and expansion duraplasty is technically feasible and results in low rates of late deterioration and re-tethering. Lipoma-type and pre-operative status are important outcome predictors. Operative risks are not insignificant. Future studies need to determine appropriate selection criteria for surgery.

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“…Despite recommendations for prophylactic surgery, this intervention is controversial [13,33]. The standard surgical procedure for FTL is laminotomy-based dissection [9]; however, less-invasive techniques have been reported [8,10,22].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Inter-laminar Approach and Laminotomy Open Approach for Filum Terminale Lipoma: A Retrospective Analysis

Nawashiro,

Kurimoto,

Nagakura

et al. 2024

Preprint

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Purpose Filum terminale lipoma (FTL) causes spinal-cord tethering and is associated with tethered-cord syndrome, which is treated by dissection of the entrapment. The conventional treatment for FTL involves dissection of the spinal cord through a laminotomy open approach (LOA). However, in recent years, the interlaminar approach (ILA) has gained popularity as a minimally invasive surgery. This study compares the effectiveness of the minimally invasive ILA with the conventional LOA in treating FTL. Methods We retrospectively evaluated data on the ILA and LOA for FTL at our center. In total, 103 participants were enrolled, including 55 in the ILA group and 48 in the LOA group. Results The ILA required significantly less surgical time and resulted in less blood loss. The improvement rate of symptoms in symptomatic patients was 84%, and for urinary symptoms and abnormal urodynamic study findings, it was 77%. The postoperative maintenance rate for asymptomatic patients was 100%. Postoperative complications of ILA included delayed wound healing in two patients (3.6%). Conclusion Compared with LOA, ILA offers advantages in terms of shorter operative time and less blood loss, with no significant difference in long-term symptom-improvement rates between the groups.

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Long-term urological outcomes of spinal lipoma after prophylactic untethering in infancy: real-world outcomes by lipoma anatomy

Cited by 11 publications

References 21 publications

Analysis of factors affecting permanent clean intermittent catheterization and bladder function after primary neurosurgical repair of lipomyelomeningocele

Analysis of factors affecting permanent clean intermittent catheterization and bladder function after primary neurosurgical repair of lipomyelomeningocele

Radical resection of lumbosacral lipomas in children: the Great Ormond Street Hospital experience

Comparison of the Inter-laminar Approach and Laminotomy Open Approach for Filum Terminale Lipoma: A Retrospective Analysis

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