Urinary Tract Dysfunctions in Tethered Spinal Cord Syndrome: Improvement After Surgical Untethering

Yoneyama, T; Fukui, Jun; Ohtsuka, Kuniyoshi; Komatsu, Hirofumi; Ogawa, Akimi

doi:10.1016/s0022-5347(17)49349-9

Cited by 34 publications

(9 citation statements)

References 8 publications

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“…Our results, as well as those reported by others [3,7,14,15], adequately document that the neurosurgical release of tethering ( fig. 5) may improve both clinical and urodynamic patterns in these children.…”

Section: Discussionsupporting

confidence: 92%

Early Diagnosis and Treatment of Spinal Dysraphism to Prevent Urinary Incontinence

M¹,

Lais²,

Fariello³

et al. 1991

Eur Urol

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Section: Discussionsupporting

confidence: 92%

Early Diagnosis and Treatment of Spinal Dysraphism to Prevent Urinary Incontinence

M¹,

Lais²,

Fariello³

et al. 1991

Eur Urol

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“…In children with double‐barreled colostomy, fecal mass easily jumps from the oral stoma to the anal one, which allows fecal contamination in the urinary tract. Neurologic bladder dysfunction from associated spinal anomalies further aggravate the risks of UTI 8 . Although the management of reflux is controversial, we did not hesitate to choose surgical repair even in early infancy if the patient had breakthrough UTI.…”

Section: Discussionmentioning

confidence: 99%

Urological management of cloacal anomalies

et al. 2001

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Background: A cloacal anomaly results from incomplete urorectal division and is frequently associated with genitourinary abnormalities. Experience of the urological reconstruction of this entity is reported. Methods: Nine girls with cloacal malformation have been treated at the Osaka Medical Center in the past 9 years. Seven patients were detected by prenatal ultrasonography as having: megacystis (two patients); hydronephrosis (two patients); or hydrometrocolpos (three patients). Two patients underwent prenatal shunt placement between the enlarged bladder and the amniotic space.Results: For neonatal urinary diversion, four patients received cystostomy. Six of seven patients with associated hydrocolpos required intermittent catheterization to decompress an enlarged vagina. Vesicoureteral reflux was detected in 12 ureters of seven patients. Antireflux surgery was indicated in four patients before definitive repair. Definitive reconstruction was performed on eight patients. The posterior sagittal approach was used in all patients. Vaginal reconstruction was done utilizing a perineal skin flap (one patient), a tubularized vaginal flap (three patients), distal rectum (three patients) and total urogenital mobilization (one patient). Postoperatively, urethrovaginal fistula was created in one patient and complete occlusion was seen in one patient. Conclusion:The anatomical variety of this entity determines the management options from in utero. It involves not only the creation of three perineal orifices, but also a continent, catheterizable urethra under the stabilization of renal function. Accomplishment of the definitive repair requires the combined expertise of experienced pediatric surgeons and pediatric urologists.

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“…This has to be noted because, at a young age, uninhibited bladder contractions, bladder-urethral dysfunction and pathological anorectal manometry might be misleading urodynamic criteria. 2,7,13,14,21,22,35,44,45 Group 2 only included children who had undergone prior myelomeningocele repair. 1,20,32 Once the diagnosis of primary tethered cord was made, all of our Group 1 patients underwent surgery, even if their symptoms and signs were nonprogressive.…”

Section: Discussionmentioning

confidence: 99%

Impact of urodynamic studies on the surgical management of spinal cord tethering

Vernet¹,

Farmer²,

Houle³

et al. 1996

Journal of Neurosurgery

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To determine the usefulness of urodynamic studies in the management of children with a suspected tethered spinal cord, the authors retrospectively reviewed case records of 25 patients evaluated both pre- and postoperatively using this diagnostic adjunct. All patients were also evaluated with magnetic resonance imaging or computerized tomography myelography. Seven patients who presented initially with orthopedic deformity, skin stigmata, and neurological problems underwent primary cord untethering (Group 1). All seven patients were urologically asymptomatic; all but one had normal findings on urodynamic study. Eighteen patients with prior myelomeningocele closure underwent secondary untethering (Group 2). They presented with urological (11 cases), neurological (three cases), or both urological and neurological (four cases) deterioration. All patients underwent surgery via a microsurgical technique. At a mean follow-up time of 2 years, the only Group 1 patient with preoperative abnormal urodynamic findings normalized following untethering, whereas another asymptomatic patient showed worsened results on his postoperative study. In Group 2, all seven patients with preoperative neurological deterioration improved. Ten of the 15 patients who had isolated or associated preoperative clinical urological deterioration improved or stabilized, whereas five displayed continued deterioration in their bladder function. With respect to urodynamic studies, there was a significant increase in total and pressure-specific bladder capacities following untethering. We conclude that urodynamic studies are useful both diagnostically and in follow-up examinations of patients with tethered cord, that disturbances identified by these studies often precede clinical manifestations of deterioration, and that spinal cord untethering favorably influences the urological status in most patients.

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Urinary Tract Dysfunctions in Tethered Spinal Cord Syndrome: Improvement After Surgical Untethering

Cited by 34 publications

References 8 publications

Early Diagnosis and Treatment of Spinal Dysraphism to Prevent Urinary Incontinence

Early Diagnosis and Treatment of Spinal Dysraphism to Prevent Urinary Incontinence

Urological management of cloacal anomalies

Impact of urodynamic studies on the surgical management of spinal cord tethering

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