Urodynamic Findings in the Tethered Spinal Cord: The Effect of Tethered Cord Division on Lower Urinary Tract Functions*

Balkan, Emin; Kılıç, Nizamettin; Avşar, I; Boyaci, S.; Aksoy, Kaya; Doğruyol, Hasan

doi:10.1055/s-2001-14899

Cited by 21 publications

(6 citation statements)

References 19 publications

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“…[39][40][41] Among surgical studies (n = 12), there was no clear or standardized description in the untethering technique utilized. [30][31][32][33][34]37,38,[42][43][44] Among these surgical studies, only 6 described their complications in the results section of the respective article. Additionally, 5 out of the 13 studies did not provide information on the length of follow-up after surgical intervention.…”

Section: Description Of Evaluation Results and Follow-upmentioning

confidence: 99%

“…In our systematic review, we observed differences in the diagnostic criteria of TCS and widely variable health outcomes following surgery in Asian countries. 31,[38][39][40] Our findings suggest that among studies conducted in this region, the management of TCS was aggressive in the surgical approach leading to untethering and often did not rely on the pres-ence of progressive neurologic deficits as a criterion for initial surgical treatment of spinal cord tethering. 30,33,34,42 To address the observable variation in the diagnostic criteria for TCS, Lew and Kothbauer 26 defined TCS as "a diverse clinical entity which presents with symptoms and signs resulting from abnormal spinal cord tension. "…”

Section: Global Surgery and Variance In Surgical Approach To Tcsmentioning

confidence: 90%

“…There was wide variability in the description of neurological status and also a divergence in the reasoning for conducting untethering surgery in asymptomatic cases. For example, Khoshhal et al 30 reported progressive neurologic deficit in only 13/35 (37%) of cases, while Balkan et al 31 reported that 18 of 20 of individuals (90%) had progressive neurologic deficit before surgery. Geyik et al 32 reported that 97 of 161 of the cases (60%) were asymptomatic, and Kumar et al 33 reported that 108/160 (68%) of individuals did not have motor weakness.…”

Section: Initial Clinical Presentation and Research Focusmentioning

confidence: 99%

“…The presence of neurologic symptoms was not a prerequisite for untethering in the study by Shahjouei et al 37 Lastly, only 3 studies used urodynamic testing as part of their patients' examination. 31,35,38…”

Section: Initial Clinical Presentation and Research Focusmentioning

confidence: 99%

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Towards Guideline-Based Management of Tethered Cord Syndrome in Spina Bifida: A Global Health Paradigm Shift in the Era of Prenatal Surgery

et al. 2019

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An estimated 60% of the world's population lives in Asia, where the incidence of neural tube defects is high. Aware that tethered cord syndrome (TCS) is an important comorbidity, the purpose of this systematic review was to explore the treatment of TCS among individuals living with spina bifida (SB) in Asia. MEDLINE and Embase databases were searched for relevant studies published from January 2000 to June 2018. Search terms such as 'spinal dysraphism,' 'spinabifida,' 'diastematomyelia,' 'lipomeningocele,' 'lypomyelomeningocele,' 'meningomyelocele,' and 'tethered cord syndrome' were used in diverse combinations. Of the 1,290 articles that were identified in accordance with PRISMA (Preferred Items for Systematic Reviews and Meta-Analyses) guidelines, 15 Asia-based studies met the inclusion criteria. Significant differences in the diagnostic criteria and management of TCS were documented. As the surgical techniques for prenatal closure of the spinal defect continue to evolve, their adoption internationally is likely to continue. In this setting, a clear and evidence-based approach to the definition and management of TCS is essential. The recent publication by the Spina Bifida Association of America of their updated care guidelines may serve as a tool used to promote a systematized approach to diagnosing and treating TCS among individuals with SB in the region, as well as globally.

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Section: Description Of Evaluation Results and Follow-upmentioning

confidence: 99%

Section: Global Surgery and Variance In Surgical Approach To Tcsmentioning

confidence: 90%

Section: Initial Clinical Presentation and Research Focusmentioning

confidence: 99%

Section: Initial Clinical Presentation and Research Focusmentioning

confidence: 99%

See 2 more Smart Citations

Towards Guideline-Based Management of Tethered Cord Syndrome in Spina Bifida: A Global Health Paradigm Shift in the Era of Prenatal Surgery

et al. 2019

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“…There seems to be a consensus among authors that SSCU surgery leads to improvement in urological dysfunctions in children with TCS after surgical release [9][10][11][12]15 .…”

Section: Introductionmentioning

confidence: 99%

Importance of urodynamic evaluation of bladder function after untethering in spina bifida patients – Single center experience of 30 years

Lingnau

Ciesla

Schneider

et al. 2022

Preprint

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Introduction: A TCS after primary closure of meningomyeloceles is a known complication of the spina bifida disease. Data on the outcome after SSCU surgery is heterogeneous and lacking standardization. Thus we aimed to find a reliable system for assessment of the bladder function before and after SSCU surgery and document postoperative outcome.Methods: A retrospective study was performed on a cohort of 306 patients with spina bifida diagnosis. In total, 130 patients underwent 182 SSCU surgeries, 56 of those met our inclusion criteria. A classification system, including two different methods, was used. The AC system used baseline pressure and detrusor over activity to define three levels of bladder dysfunction, the second method ranked the severity of bladder dysfunction by awarding points from 0 to 2 for bladder capacity, maximal detrusor pressure during autonomous contractions, leak point pressure and vesicoureteral reflux A high score is correlated with a severe bladder dysfunction.Results: Gender distribution was equally (male: n=29; 51,8%; female: n=27; 48,2%). The median age at SSCU was 9,02 years (range 0,5 – 22,8 years).After SSCU, the stage improved in 11 patients (19.6%), worsened in 11 (19.6%) patients and remained the same in 34 patients (60.7%) after intervention (AC score). Non-worsening was observed in a total of 45 cases (80.4%) (p<0.001).MHS score (n=27, 48,2%) improved, remained unchanged (n=12, 21.4%), 17 patients worsened (30.4%). Non-worsening in postoperative bladder functional outcome was demonstrated in 39 cases (69,6%) over all (p<0.005).Regardless of whether bladder function is categorized by AC or MHS, postoperative outcome worsened significantly when SSCU was performed due to increasing deterioration in motor function alone (p<0.05). Of the 24 cases with NOD as indication, 22 (91,7%) had an unchanged (n=10; 41,7%) or improved (n=12; 50,0%), meaning positive neuro-orthopedic outcome, only 2 (8,3%) deteriorated (p<0,001).Conclusion: Our study presents reliable evaluation systems for bladder function in spina bifida patients. Since indications for SSCU surgery differ, it is important to know the possible effects on bladder function after this surgical procedure. Even a mild impairment of bladder function has a risk to deteriorate after SSCU surgery. Particularly interesting becomes this with regard to the fact that the prevalence of TCS might become more frequent with the rising numbers of prenatal closures of meningomyeloceles.

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Complications of the Occult Spinal Dysraphisms

Bruzek

Maher

2019

Occult Spinal Dysraphism

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Urodynamic Findings in the Tethered Spinal Cord: The Effect of Tethered Cord Division on Lower Urinary Tract Functions*

Abstract: Lower urinary tract dysfunctions secondary to tethered cord syndrome are very common in spinal dysraphic cases and significant improvements can be achieved with a judiciously timed division of the spinal tethered cord.

Cited by 21 publications

References 19 publications

Towards Guideline-Based Management of Tethered Cord Syndrome in Spina Bifida: A Global Health Paradigm Shift in the Era of Prenatal Surgery

Towards Guideline-Based Management of Tethered Cord Syndrome in Spina Bifida: A Global Health Paradigm Shift in the Era of Prenatal Surgery

Importance of urodynamic evaluation of bladder function after untethering in spina bifida patients – Single center experience of 30 years

Complications of the Occult Spinal Dysraphisms

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