Adverse urologic consequences of spinal cord resection at the time of kyphectomy: Value of preoperative urodynamic evaluation

Four children with thoracic level paraplegia and severe myelokyphosis under went distal spinal cord resection at the time of kyphectomy. All four child ren were continent before spinal cord resection and became incontinent imme diately afterward. Two children in retrospect had preoperative urodynamics that showed intact innervation to the external sphincter, and two had no pr eoperative urodynamic studies. All four had evidence of lower urinary tract denervation on urodynamic studies performed after cord resection. The urol ogic and urodynamic consequences of spinal cord resection at the time of ky phectomy in children with myelodysplasia are reviewed. Resection of the dis tal spinal cord in thoracic level myelodysplasia may cause postoperative in continence in some previously continent patients. Prc operative urodynamic evaluation and urologic consultation is recommended. If individual evaluati on indicates that residual sacral function is beneficial to urologic manage ment, kyphectomy without cord resection is preferable.