Effect of early tethered cord release on urodynamic findings and lower urinary tract function in myelomeningocele patients.

Abstract

Objective: Detecting neurological deterioration and diagnosing tethered cord syndrome (TCS) in patients with myelomeningocele (MMC) can be challenging due to the presence of symptoms at birth and the lack of objective indicators. This retrospective analysis focused on urological manifestations and evaluated whether tethered cord release (TCR) for TCS at an early stage could improve or stabilize video urodynamic study (VUDS) findings and lower urinary tract function.

Methods: This study analyzed 55 of 64 children who underwent MMC repair at Miyagi Children's Hospital, Sendai, Japan, between 2003 and 2016. The follow-up duration for these children exceeded 6 years. Clinical records were reviewed, and surgical indicators and outcomes of TCR and preoperative and postoperative results of VUDS were evaluated.

Results: The duration of follow-up was mean ± SD (range) 12.6 ± 3.5 (6.0-19.0) years. TCR was performed on 27 (49.1%) of 55 patients with MMC, totaling 33 procedures. Five patients underwent 2 TCR procedures, whereas 1 received 3 TCR procedures. The mean ± SD (range) age was 7.5 ± 2.9 (2.2-12.7) years at the first TCR procedure (n = 27) and the mean (range) was 10.9 (10.1-11.7) years at the second TCR (n = 5); in addition, 1 patient underwent a third TCR procedure at age 15.9 years. There were no identified risk factors associated with the TCS. The first TCR procedure was performed due to worsened lower-extremity (LE) motor symptoms in 1 patient, worsened LE sensory symptoms in 3 patients, and worsened VUDS findings in 26 patients. After the procedure, LE motor symptoms improved in 1 patient (100%), LE sensory symptoms improved in 2 patients (66.7%), and VUDS findings improved in 18 patients (66.7%). Preoperative VUDS revealed urological deterioration characterized by a high-pressure bladder, reduced bladder capacity, increased detrusor overactivity (DO), and vesicoureteral reflux. Postoperative VUDS showed improvements in bladder function, including decreased bladder pressure and DO, increased bladder capacity, and compliance. None of the patients underwent augmentation cystoplasty or had renal dysfunction.

Conclusions: Routine VUDS can detect urological deterioration, which can be a significant indicator for early diagnosis of TCS. Performing TCR at an early stage is beneficial, not only to protect renal function but also to improve VUDS findings and lower urinary tract function in patients with MMC. It is important to explore a standardized approach for the diagnosis and treatment of TCS.