Urodynamic findings in the tethered spinal cord: The effect of tethered cord division on lower urinary tract functions

Purpose: The aim of this study is to evaluate the effect of division of the tethered spinal cord urodynamically in spinal dysraphic cases. Methods: Be tween 1995-1997 20 cases (11 males, 9 females) aged from 5 months to 13 fea rs with TSC were Investigated. 13 cases (65%) were classed as belonging to the myelomeningocele group and 5 cases (35%) to the spina bifida occulta gr oup. We used a computerized urodynamic system to evaluate the functions of the lower urinary tracts pre- and postoperatively. The definitive diagnosis of cord tethering was made using magnetic resonance imaging (MRI) in 19 ca ses (95%) and spinal ultrasound in 1 case (5%). Division of filum terminale and laminectomy were carried out in all cases by the Neurosurgery Departme nt, and 2 cases with retethering were operated on twice. Results: All of th ese cases were assessed urodynamically in the preoperative and postoperativ e period. Significant improvements were noted in detrusor functions (35%); electromyography recordings (45%): high leak point pressures (55%) and anal and urinary continence (70%). Conclusion: Lower urinary tract dysfunctions secondary to tethered cord syndrome are very common in spinal dysraphic ca ses and significant improvements can be achieved with a judiciously timed d ivision of the spinal tethered cord.