SUBCLINICAL CHANGES IN BLADDER FUNCTION IN CHILDREN PRESENTING WITH NONUROLOGICAL SYMPTOMS OF THE TETHERED CORD SYNDROME

Purpose: We evaluated the urodynamic findings in myelodysplastic child ren with the tethered cord syndrome without urological symptoms to det ermine if occult bladder changes occur or if routine preoperative urod ynamic evaluation is not indicated for this select population. Materia ls and Methods: Preoperative and postoperative urodynamic studies were performed on children with myelodysplasia and the tethered cord syndr ome between 1988 and 1994. Inclusion criteria were neurological or mus culoskeletal surgical indications only, without urological status chan ges, radiographic confirmation of the tethered cord syndrome, and wate r cystometry performed preoperatively within 1 week and again postoper atively within 6 months. The parameters of interest included total bla dder capacity and pressure, leak point pressure, compliance, uninhibit ed contractions, electromyelogram activity and sensation.Results: A to tal of 20 children, 11 girls and 9 boys, 2.3 to 17.3 years old were in cluded in the study. Worsening scoliosis and lower extremity weakness were the most common presentations. Urodynamic studies were conducted 1.8 days preoperatively (mean) and 104.3 days postoperatively (mean). Results were analyzed with regard to improvement or deterioration betw een preoperative and postoperative urodynamic studies. Of the 20 child ren 15 (75%) demonstrated improvement between the 2 urodynamic studies , including 10 who improved in 1 parameter (most often with resolution of uninhibited contractions), 3 in 2, 1 in 3 and 1 in 4. There were n o significant postoperative changes for any of the specific parameters . Urodynamic studies identified 7 children with preoperative leak poin t pressures above 40 cm. water, of whom only 2 had decreased pressures below 40 cm. water, 2 had postoperative deterioration of compliance a nd 1 had preoperative detrusor-sphincter dyssynergia. Conclusions: Rou tine preoperative and postoperative urodynamic evaluations in children with the tethered cord syndrome without clinical changes to urologica l status may be important. The majority of clinically asymptomatic chi ldren will demonstrate preoperative urodynamic findings that improve p ostoperatively, which serves as another marker of progress after spina l cord untethering. Moreover, some asymptomatic children will demonstr ate changes to the urinary tract that merit management changes, such a s detrusor-sphincter dyssynergia, elevated bladder storage pressures a nd poor compliance, which may have otherwise been delayed in recogniti on.