Predictors of urinary continence following tethered cord release in children with occult spinal dysraphism

Frainey, Brendan; Yerkes, Elizabeth B.; Menon, Vani S.; Gong, Edward M.; Meyer, Theresa; Bowman, Robin; McLone, David G.; Cheng, Earl Y.

doi:10.1016/j.jpurol.2014.06.008

Cited by 25 publications

(10 citation statements)

References 14 publications

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“…61 This involved a heterogeneous population, but no factor independently predicted continence after surgery, including age, type of skin lesion, level of conus, presence or absence of hydronephrosis, or vesicoureteral reflux. 61 Improvement in LUT function for those with neurogenic bladder diagnosed before surgery also vary widely, from 11.5% to 59%, depending on severity of LUT dysfunction before surgery and OSD type. 34,36,37,83,[87][88][89] Outcomes are variable: Children with OTSC having a 50% rate of UDS improvement, SCM improving in 1/3 and complex LMM only 11% improvement.…”

Section: Urologic Outcomementioning

confidence: 98%

“…MRI finding of a thickened or fatty filum (>3 mm) occurs in 1.5‐5% of the population; it can be associated with TSC, alone or with other forms of OSD . SCU for thickened or fatty fila carries a low surgical risk, but surgery for radiographic findings must be limited.…”

Section: Special Considerations According To Osd Typementioning

confidence: 99%

“…In assessing outcomes 10 years after SCU for non‐complex lipomas comprising fatty fila and low conus, Frainey et al found unchanged continence for all continent patients before surgery; whereas only 45% of those incontinent preoperatively regained continence . This involved a heterogeneous population, but no factor independently predicted continence after surgery, including age, type of skin lesion, level of conus, presence or absence of hydronephrosis, or vesicoureteral reflux …”

Section: Short and Long Term Surgical Outcomesmentioning

confidence: 99%

“…MRI finding of a thickened or fatty filum (>3 mm) occurs in 1.5-5% of the population; it can be associated with TSC, alone or with other forms of OSD. 11,13,61 SCU for thickened or fatty fila carries a low surgical risk, but surgery for radiographic findings must be limited. Most neurosurgeons do not recommend prophylactic untethering for asymptomatic patients with isolated fatty or thickened fila found incidentally, except for the infant or child with an unequivocally low conus or an associated ARM.…”

Section: Thickened or Fatty Filummentioning

confidence: 99%

See 3 more Smart Citations

Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children's continence society

Tuite

Thompson

Austin

et al. 2017

Neurourology and Urodynamics

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Infants with classic cutaneous markers of OSD, with progressive neurologic, skeletal, and/or urologic findings, present no diagnostic or therapeutic dilemma: they routinely undergo MRI and SCU. Conversely, in asymptomatic patients or those with fixed, minor abnormalities, the risk profile of these OSD cohorts should be carefully considered before SCU is performed. Irrespective of whether or not SCU is performed, patients at risk for progression should be followed carefully throughout childhood and adolescence by a multidisciplinary team.

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Section: Urologic Outcomementioning

confidence: 98%

Section: Special Considerations According To Osd Typementioning

confidence: 99%

Section: Short and Long Term Surgical Outcomesmentioning

confidence: 99%

Section: Thickened or Fatty Filummentioning

confidence: 99%

See 2 more Smart Citations

Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children's continence society

Tuite

Thompson

Austin

et al. 2017

Neurourology and Urodynamics

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“…These findings added to a growing body of literature evaluating clinical outcomes following primary TCR in occult spinal dysraphism. In a recent series from our institution, although asymptomatic children with cutaneous lesions had excellent continence rates post-TCR, no specific urodynamic parameters were associated with urologic outcomes [ 26 ]. Similarly, in a second series of 40 children although significant improvement in both continence and UTI rates were observed following secondary TCR, preoperative neurologic symptoms prompting TCR were not a predictor of urologic outcomes [ 27 ].…”

Section: Predictive Urologic Changes In Tethered Cord Releasementioning

confidence: 99%

The Management of the Pediatric Neurogenic Bladder

Cheng

2016

Curr Bladder Dysfunct Rep

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Neurogenic bladder is a heterogeneous entity that may result from a variety of conditions affecting the central or peripheral nervous systems. Regardless of etiology, the overall goals of management are primarily twofold. As a neurogenic bladder may affect the ability to store urine safely and to empty the bladder efficiently, early management is focused on optimization of bladder storage function to prevent irreversible injury to either the upper or lower urinary tracts. In older children, this goal is added to the challenge of maximizing quality of life through achievement of urinary continence and independence in bladder management that continues into the transition to adulthood.In this review, we seek to bring the reader up-to-date regarding management of the pediatric neurogenic bladder with a focus on literature published in the past year. We discuss key contributions related to fetal intervention for myelomeningocele, monitoring and medical management of the neurogenic bladder and prediction of postoperative outcomes. Put together, these studies highlight the continued need for further research to improve evidence-based medical and surgical decision-making strategies for children affected by neurogenic bladder.

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Botulinum toxin in patients at‐risk for bladder augmentation: Durable impact or kicking the can?

Bowen

Meyer

Rosoklija

et al. 2022

Neurourology and Urodynamics

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Deferring bladder augmentation (BA) may be desirable in a pediatric neurogenic bladder (NGB) with worsening compliance, but prior studies have questioned whether onabotulinum toxin A (BTX) demonstrates durable improvement in compliance. We present our overall experience with BTX and its role in mitigating the "at-risk" NGB, as determined by urodynamic characteristics.Methods: A retrospective single-institution review of all BTX procedures performed during January 2010 to October 2018 was conducted. Patients with <12 months follow-up after first BTX injection were excluded. Urodynamic studies (UDS) were reviewed to assign National Spina Bifida Patient Registry (NSBPR) as well as institutionally developed (LCH) risk classification groups.Patients were considered "at-risk" for BA if they had any of the following: NSBPR risk grade of intermediate or hostile; LCH risk grades indicating endfill pressure >25 cmH 2 O or detrusor sphincter dyssynergia (DSD); upper tract changes including new hydronephrosis; new or worsening vesicoureteral reflux; or other signs of a hostile urinary tract (i.e., febrile UTIs). UDS risk grades pre and post-first BTX injection were compared in this "at-risk" group, when available.Results: Thirty-nine patients underwent 162 injection procedures over a median follow-up of 65 months interquartile range . Median age at first BTX was 10 years and the median number of BTX injections per patient was 4 (IQR 2-7; range 1-12) with a median time of 6 months between injections (IQR 4-10). Twenty-six patients were deemed "at-risk" at the time of first BTX injection, and of those, 16 (61.5%) proceeded to BA at a median of 36 months . A small number (four) had BA due to upper tract changes or worsening pressures on BTX, while nine patients (five with CKD) proceeded to BA given a lack of sufficient improvement to consider BTX a long-term viable option. Post-first BTX UDS demonstrated downgrading of risk group in 38% and 63% using NSBPR and LCH classifications, respectively.

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Predictors of urinary continence following tethered cord release in children with occult spinal dysraphism

Cited by 25 publications

References 14 publications

Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children's continence society

Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children's continence society

The Management of the Pediatric Neurogenic Bladder

Botulinum toxin in patients at‐risk for bladder augmentation: Durable impact or kicking the can?

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