Urological assessment for tethered cord syndrome of delayed onset following repair of meningomyelocele

Takashige Namima, Keiichirou Uchi, Haruo Nakagawa, Masataka Aizawa, Seiichi Orikasa

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

(Purpose and Materials) Out of 84 patients with meningomyelocele repaired at birth, 14 (15, 7%) children (6 boys and 8 girls, average 8.8 year-old) who underwent cord untethering for tethered cord syndrome of delayed onset (Delayed TCS) were urologically evaluated. (Results) Eleven (78.5%) children were detected orthopedically by deterioration of lower extremities function and only 3 (21.5%) were detected urologically. Preoperative urodynamic study, however, revealed in 5 children aggravation of urinary tract dysfunction, including uninhibited contraction in 4, impaired bladder compliance in 3, decreased bladder capacity in 2 and recurrence of VUR in 1. Although there were no particular urinary symptoms for detection of Delayed TCS, acceration of uninhibited contraction seemed to be one of the most important findings. After untethering, deterioration or normalization of urological dysfunction was not seen. Six of 14 children had favorable clinical results, such as improvement of uninhibited contraction, increasing of bladder compliance and capacity, prolongation of dry time and disappearance of VUR. In 3 children Delayed TCS were detected by postoperative improvement of urinary tract function. Consequently, of 14 children who were evaluated preoperative and postoperatively 8 (52, 7%) had urological impairment compatible with Delayed TCS. (Conclusion) It is not easy to detect the urological deteriorations associated with Delayed TCS behind initial neuro-urological deficits. Careful and regular follow-up examinations are required to early detection of Delayed TCS. The fact that urinary tract dysfunction improved in some cases after untethering encourages aggressive surgical untethering of Delayed TCS.

Original languageEnglish
Pages (from-to)1158-1166
Number of pages9
JournalJapanese Journal of Urology
Volume87
Issue number10
DOIs
Publication statusPublished - 1996 Oct

Keywords

  • surgical untethering
  • tethered cord syndrome
  • urinary tract dysfunction

ASJC Scopus subject areas

  • Urology

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