Utility of urodynamics in the management of asymptomatic tethered cord in children

Abstract

In children with asymptomatic tethered cord, abnormal preoperative UDS may prompt intervention, while normal UDS do not appear to prevent intervention. There is no significant correlation between abnormal preoperative UDS and abnormal preoperative imaging. Further study is needed to evaluate the utility of this procedure in the preoperative setting in this asymptomatic patient population.

Preoperative Videourodynamic Study Is Helpful in Predicting Long-term Postoperative Voiding Function in Asymptomatic Patients With Closed Spinal Dysraphism

“…We have first attempted correlation of preoperative urodynamic parameters with long-term clinical variables like spontaneous voiding or incontinence at the time of TT or after 2 years of TT. This is more feasible than comparing with those of single postoperative UDS, considering aforementioned reduced compliance as reported by Broderick et al [ 5 ] Furthermore, continuing maturation of bladder function would confuse the interpretation.…”

“…Given poor verbal communication in all patients, up to 1/3 of children were said to be uncooperative during the UDS. [5] To circumvent this non-physiological situation, performing UDS under placement of suprapubic catheter or sedation can be considered. This also appears invasive and could adversely affect some urodynamic parameters.…”

“…Some detected abnormal bladder functions, others reported changes in urodynamic variables following SCU, though parameters that were reported to undergo changes after SCU were not consistent between them. [2,4,5,[7][8][9][10][11][12][13][14][15][16][17] This was at least partially due to the fact that most studies compared single postoperative UDS performed in various postoperative periods with preoperative one, ignoring the possibility of developing bladder function in children. Thus, inclusion of urodynamic data performed regular postoperative periods would be more ideal but this is impractical and sometimes too invasive to most patients with normal spontaneous voiding.…”

“…Meanwhile, performing and interpreting UDS for infants with suspicious TCS is challenging even in experienced urologists. Given poor verbal communication in all patients, up to 1/3 of children were said to be uncooperative during the UDS [ 5 ]. To circumvent this nonphysiological situation, performing UDS under placement of suprapubic catheter or sedation can be considered.…”

“…Up to now, dozens of studies have described the urodynamic changes following SCU and attempted to reveal the role of preoperative UDS. Some detected abnormal bladder functions, others reported changes in urodynamic variables following SCU, though parameters that were reported to undergo changes after SCU were not consistent between them [ 2 , 4 , 5 , 7 - 17 ]. This was at least partially due to the fact that most studies compared single postoperative UDS performed in various postoperative periods with preoperative one, ignoring the possibility of developing bladder function in children.…”