Urodynamic findings in adults with the tethered cord syndrome

Purpose: We evaluated bladder function in adults with the tethered cord syn drome using multichannel urodynamics. Materials and Methods: A total of 21 patients a mean 39.6 years old (range 20 to 62) with a tethered cord were evaluated. Of the patients 13 were diag nosed with a tethered cord as an adult and 8 had undergone previous spinal surgery. The tethered cord syndrome was diagnosed by magnetic resonance ima ging in 20 patients and computerized tomography myelogram in 1. All patient s underwent complete neurological and urological evaluation, including mult ichannel urodynamics. Needle electromyography and video urodynamics were pe rformed in select cases. Microsurgical release of the tethered cord was per formed in 19 patients and 2 refused surgery. Urodynamics were done before s urgery in 16 of 19 patients and a median of 12.5 months (range 1 to 40) aft er surgery in 14. In addition, intraoperative urodynamic monitoring and ner ve root stimulation were done in 14 patients to prevent nerve root injury a t surgery. Results: At presentation urgency (67%) and urge incontinence (50%) were the most common findings in 18 patients with urinary symptoms. Pretreatment ur odynamics in 18 of 21 patients revealed hyperreflexia in 13 (72%), external detrusor-sphincter dyssynergia in 4 (22%), decreased sensation in 4 (22%), decreased compliance in 3 (17%) and hypocontractile detrusor in 2 (11%). P ostoperative urodynamic findings were improved in 4 patients (29%) and unch anged in 10 (71%). Preoperative external detrusor-sphincter dyssynergia in 4 patients resolved postoperatively in 3 and was unchanged in 1. Urinary sy mptoms were improved in 19% of patients (4), unchanged in 76% (16) and wors e in 5% (1). To date 7 patients require anticholinergics, 4 require clean i ntermittent catheterization and 1 is taking an alpha-blocker. Conclusions: Adults with the tethered cord syndrome are less likely to have urodynamic or symptom improvement after cord release and most often presen t with irreversible findings which rarely become worse after surgery. These patients need to have careful and continuous followup, including urodynami c studies, due to possible re-tethering with time.