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01-06-2016 | Original Paper

Urodynamic outcomes of detethering in children: experience with 46 pediatric patients

Authors: Murat Geyik, Sırma Geyik, Haluk Şen, Serhat Pusat, Mehmet Alptekin, Ali Erdem Yılmaz, Mert Nazik, İbrahim Erkutlu

Published in: Child's Nervous System | Issue 6/2016

Abstract

Aim

Tethered cord syndrome (TCS) manifests with neurological and urological complaints. Surgical detethering is the main treatment for TCS. Children with urological symptoms are required objective pre- and postoperative evaluations in order to predict urological outcome. The aims of this study are to investigate the effects of detethering procedure on the urodynamic tests and to determine the relationship between the changes of urodynamic tests and the patients’ age and gender.

Material and methods

The data of urodynamic tests in 46 pediatric patients, who underwent surgery for TCS, were retrospectively evaluated. Bladder capacity, post-voiding residual urine volume, maximum intravesical pressure, and bladder compliance of each patient were measured in preoperative period and at the third month after surgery. These parameters were statistically compared, and the correlations of these parameters with age, gender, and etiology of the TCS were also investigated.

Results

Bladder capacity and post-voiding residual urine volume were decreased and maximum intravesical pressure and bladder compliance were increased after surgery for TCS. The decrease in bladder capacity was significant in patients older than 10 years (p < 0.05). The increase in maximum intravesical pressure was also positively correlated with age (p < 0.05). But the increase in bladder compliance was negatively correlated with age (p < 0.05).

Conclusion

Bladder capacity, post-voiding residual urine volume, and bladder compliance are mainly affected by surgery in patients with TCS. From the urological viewpoint, children older than 10 years are most likely to benefit from surgery for TCS.

Abrahamsson K, Olsson I, Sillén U (2007) Urodynamic findings in children with myelomeningocele after untethering of the spinal cord. J Urol 177(1):331–334CrossRefPubMed

Ailawadhi P, Kale SS, Agrawal D, Mahapatra AK, Kumar R (2012) Primary tethered cord syndrome—clinical and urological manifestations, diagnosis and management: a prospective study. Pediatr Neurosurg 48(4):210–215CrossRefPubMed

Akay KM, Izci Y, Baysefer A, Timurkaynak E (2004) Split cord malformation in adults. Neurosurg Rev 27(2):99–105CrossRefPubMed

Alzahrani A, Alsowayan O, Farmer JP, Capolicchio JP, Jednak R, El-Sherbiny M (2015) Comprehensive analysis of the clinical and urodynamic outcomes of secondary tethered spinalcord before and after spinal cord untethering. J Pediatr Urol S1477-5131(15):00351–00354CrossRef

Balkan E, Kiliç N, Avşar I, Boyaci S, Aksoy K, Doğruyol H (2001) Urodynamic findings in the tethered spinal cord: the effect of tethered cord division on lower urinary tract functions. Eur J Pediatr Surg 11(2):116–119CrossRefPubMed

Başar H, Aydoğanli L, Yüksel M, Başar M, Akdemir G, Kaptanoğlu E (1997) The outcome of urological findings in operated tethered cord patients. Int Urol Nephrol 29(2):167–171CrossRefPubMed

Broderick KM, Munoz O, Herndon CD, Joseph DB, Kitchens DM (2015) Utility of urodynamics in the management of asymptomatic tethered cord in children. World J Urol 33(8):1139–1142CrossRefPubMed

Dushi G, Frey P, Ramseyer P, Vernet O, Meyrat BJ (2011) Urodynamic score in children with lipomyelomeningocele: a prospective study. J Urol 186(2):655–659CrossRefPubMed

Frainey BT, Yerkes EB, Menon VS, Gong EM, Meyer TA, Bowman RM, McLone DG, Cheng EY (2014) Predictors of urinary continence following tethered cord release in children with occult spinal dysraphism. J Pediatr Urol 10(4):627–633CrossRefPubMed

10.

Garceau GJ (1953) The filum terminale syndrome (the cord traction syndrome). J Bone Joint Surg Am 35:711–716PubMed

11.

Geyik M, Alptekin M, Erkutlu I, Geyik S, Erbas C, Pusat S, Kural C (2015) Tethered cord syndrome in children: a single-center experience with 162 patients. Childs Nerv Syst 31(9):1559–1563CrossRefPubMed

12.

Gross AJ, Michael T, Godeman F, Weigel K, Huland H (1993) Urological findings in patients with neurosurgically treated tethered spinal cord. J Urol 149(6):1510–1511PubMed

13.

Guerra LA, Pike J, Milks J, Barrowman N, Leonard M (2006) Outcome in patients who underwent tethered cord release for occult spinal dysraphism. J Urol 176(4 Pt 2):1729–1732CrossRefPubMed

14.

Hsieh MH, Perry V, Gupta N, Pearson C, Nguyen HT (2006) The effects of detethering on the urodynamics profile in children with a tethered cord. J Neurosurg 105(5 Suppl):391–395PubMed

15.

Izci Y, Gonul M, Gonul E (2007) The diagnostic value of skin lesions in split cord malformations. J Clin Neurosci 14(9):860–863CrossRefPubMed

16.

Izci Y, Taskaynatan MA (2004) Management of lower back pain in young Turkish recruits. Mil Med 169(10):824–828CrossRefPubMed

17.

Kang HS, Wang KC, Kim KM, Kim SK, Cho BK (2006) Prognostic factors affecting urologic outcome after untethering surgery for lumbosacral lipoma. Childs Nerv Syst 22(9):1111–1121CrossRefPubMed

18.

Kim SW, Ha JY, Lee YS, Lee HY, Im YJ, Han SW (2014) Six-month postoperative urodynamic score: a potential predictor of long-term bladder function after detethering surgery in patients with tethered cord syndrome. J Urol 192(1):221–227CrossRefPubMed

19.

Kothari MJ, Bauer SB, Logigian EL, Shefner JM (1995) Electrophysiological and urodynamic studies to monitor surgical outcome in children with tethered spinal cords. Muscle Nerve 18(12):1373–1377CrossRefPubMed

20.

Kumar R, Singhal N, Gupta M, Kapoor R, Mahapatra AK (2008) Evaluation of clinico-urodynamic outcome of bladder dysfunction after surgery in children with spinal dysraphism—a prospective study. Acta Neurochir 150(2):129–137CrossRefPubMed

21.

Kural C, Guresci S, Simsek GG, Arslan E, Tehli O, Solmaz I, Izci Y (2014) Histological structure of filum terminale in human fetuses. J Neurosurg Pediatr 13(4):362–367CrossRefPubMed

22.

Kural C, Solmaz I, Pusat S, Kırık A, Kaya S, Temiz C, Izci Y (2013) Surgical technique for split cord malformations: pitfalls and solution pathways. Gulhane Med J 55(2):77–83CrossRef

23.

Lavallée LT, Leonard MP, Dubois C, Guerra LA (2013) Urodynamic testing—is it a useful tool in the management of children with cutaneous stigmata of occult spinal dysraphism? J Urol 189(2):678–683CrossRefPubMed

24.

Macejko AM, Cheng EY, Yerkes EB, Meyer T, Bowman RM, Kaplan WE (2007) Clinical urological outcomes following primary tethered cord release in children younger than 3 years. J Urol 178(4 Pt 2):1738–1742CrossRefPubMed

25.

Meyrat BJ, Tercier S, Lutz N, Rilliet B, Forcada-Guex M, Vernet O (2003) Introduction of a urodynamic score to detect pre- and postoperative neurological deficits inchildren with a primary tethered cord. Childs Nerv Syst 19(10–11):716–721CrossRefPubMed

26.

Meyrat BJ, Vernet O, Berger D, de Tribolet N (1993) Pre- and postoperative urodynamic and anorectal manometric findings in children operated upon for a primary tethered cord. Eur J Pediatr Surg 3(5):309–312CrossRefPubMed

27.

Nogueira M, Greenfield SP, Wan J, Santana A, Li V (2004) Tethered cord in children: a clinical classification with urodynamic correlation. J Urol 172(4 Pt 2):1677–1680CrossRefPubMed

28.

Oakes WJ (1996) The borderlands of the primary tethered cord syndrome. Clin Neurosurg 43:188–202PubMed

29.

Pang D, Dias MS, Ahab-Barmada M (1992) Split cord malformation: part I: a unified theory of embryogenesis for double spinal cord malformations. Neurosurgery 31(3):451–480CrossRefPubMed

30.

Proctor MR, Bauer SB, Scott RM (2000) The effect of surgery for split spinal cord malformation on neurologic and urologic function. Pediatr Neurosurg 32(1):13–19CrossRefPubMed

31.

Rendeli C, Ausili E, Tabacco F, Focarelli B, Massimi L, Caldarelli M, Tamburrini G, Di Rocco C (2007) Urodynamic evaluation in children with lipomeningocele: timing for neurosurgery, spinal cord tethering and follow up. J Urol 177(6):2319–2324CrossRefPubMed

32.

Selcuki M, Mete M, Barutcuoglu M, Duransoy YK, Umur AS, Selcuki D (2015) Tethered cord syndrome in adults: experience of 56 patients. Turk Neurosurg 25(6):922–929PubMed

33.

Selçuki M, Unlü A, Uğur HC, Soygür T, Arikan N, Selçuki D (2000) Patients with urinary incontinence often benefit from surgical detethering of tight filum terminale. Childs Nerv Syst 16(3):150–154CrossRefPubMed

34.

Selçuki M, Vatansever S, Inan S, Erdemli E, Bağdatoğlu C, Polat A (2003) Is a filum terminale with a normal appearance really normal? Childs Nerv Syst 19(1):3–10PubMed

35.

Solmaz I, Izci Y, Albayrak B, Cetinalp E, Kural C, Sengul G, Gocmez C, Pusat S, Tuzun Y (2011) Tethered cord syndrome in childhood: special emphasis on the surgical technique and review of the literature with our experience. Turk Neurosurg 21(4):516–521PubMed

36.

Tarcan T, Onol FF, Ilker Y, Simsek F, Ozek M (2006) Does surgical release of secondary spinal cord tethering improve the prognosis of neurogenic bladder in children with myelomeningocele? J Urol 176(4 Pt 1):1601–1606CrossRefPubMed

37.

Tehli O, Hodaj I, Kural C, Solmaz I, Onguru O, Izci Y (2011) A comparative study of histopathological analysis of filum terminale in patients with tethered cord syndrome and in normal human fetuses. Pediatr Neurosurg 47(6):412–416CrossRefPubMed

38.

Valentini LG, Selvaggio G, Erbetta A, Cordella R, Pecoraro MG, Bova S, Boni E, Beretta E, Furlanetto M (2013) Occult spinal dysraphism: lessons learned by retrospective analysis of 149 surgical cases about natural history, surgical indications, urodynamic testing, and intraoperative neurophysiological monitoring. Childs Nerv Syst 29(9):1657–1669CrossRefPubMed

39.

Vernet O, Farmer JP, Houle AM, Montes JL (1996) Impact of urodynamic studies on the surgical management of spinal cord tethering. J Neurosurg 85(4):555–559CrossRefPubMed

40.

White JT, Samples DC, Prieto JC, Tarasiewicz I (2015) Systematic review of urologic outcomes from tethered cord release in occult spinal dysraphism in children. Curr Urol Rep 16(11):78CrossRefPubMed

41.

Yamada S (2004) Tethered cord syndrome in adults and children. Neurol Res 26(7):717–718CrossRefPubMed

42.

Yamada S, Iacono RP, Andrade T, Mandybur G, Yamada BS (1995) Pathophysiology of tethered cord syndrome. Neurosurg Clin N Am 6(2):311–323PubMed

43.

Yamada S, Won DJ, Pezeshkpour G, Yamada BS, Yamada SM, Siddiqi J, Zouros A, Colohan AR (2007) Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg Focus 23(2):E6CrossRefPubMed

44.

Yener S, Thomas DT, Hicdonmez T, Dagcinar A, Bayri Y, Kaynak A, Dagli TE, Tugtepe H (2015) The effect of untethering on urologic symptoms and urodynamic parameters in children with primary tethered cord syndrome. Urology 85(1):221–226CrossRefPubMed

45.

Zöller G, Schöner W, Ringert RH (1991) Pre- and postoperative urodynamic findings in children with tethered spinal cord syndrome. Eur Urol 19(2):139–141PubMed

Title: Urodynamic outcomes of detethering in children: experience with 46 pediatric patients
Authors: Murat Geyik
Sırma Geyik
Haluk Şen
Serhat Pusat
Mehmet Alptekin
Ali Erdem Yılmaz
Mert Nazik
İbrahim Erkutlu
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 6/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-016-3053-y

At a glance: The STEP trials

Springer Medicine

Urodynamic outcomes of detethering in children: experience with 46 pediatric patients

Abstract

Aim

Material and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Aim

Material and methods

Results

Conclusion

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