473 UROLOGIC OUTCOMES AFTER PRIMARY TETHERED CORD RELEASE IN CHILDREN WITH OCCULT SPINAL DYSRAPHISM (OSD): A 10 YEAR SINGLE INSTITUTION REVIEW

Abstract

You have accessJournal of UrologyPediatrics: Neuropathic Bladder/Reconstruction1 Apr 2013473 UROLOGIC OUTCOMES AFTER PRIMARY TETHERED CORD RELEASE IN CHILDREN WITH OCCULT SPINAL DYSRAPHISM (OSD): A 10 YEAR SINGLE INSTITUTION REVIEW Niki Kanaroglou, Elias Wehbi, Joseph M Gleason, Reva Matta, Joao Pippi Salle, James Drake, Sumit Dave, Armando Lorenzo, and Walid Farhat Niki KanaroglouNiki Kanaroglou Toronto, Canada More articles by this author , Elias WehbiElias Wehbi Toronto, Canada More articles by this author , Joseph M GleasonJoseph M Gleason Toronto, Canada More articles by this author , Reva MattaReva Matta Beirut, Lebanon More articles by this author , Joao Pippi SalleJoao Pippi Salle Toronto, Canada More articles by this author , James DrakeJames Drake Toronto, Canada More articles by this author , Sumit DaveSumit Dave London, Canada More articles by this author , Armando LorenzoArmando Lorenzo Toronto, Canada More articles by this author , and Walid FarhatWalid Farhat Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1865AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES OSD varies from a clear anatomic abnormality to equivocal MRI pathology in the presence of clinical symptoms. Urologic symptoms (Ux) are sometimes the only indication for neurosurgical intervention but the benefit of this is still unclear. Herein, we describe the urologic outcomes of tethered cord release in children with OSD. METHODS Records of patients aged 0-18 years undergoing primary tethered cord release for OSD at our institution were reviewed (2000-2010). Patients with open spinal defects, lipomyelomeningoceles, secondary tethering, spinal trauma and tumors were excluded. MRI pathology, indications for surgery and the presence of lumbar cutaneous stigmata (CS) were correlated with Ux before and after surgery. Ux included subjective urinary symptoms (eg. frequency, urgency), incontinence, constipation, urinary infections and need for intermittent catheterization. Clinical history, renal ultrasonography and urodynamics (UDS) were assessed. RESULTS 216 patients underwent untethering and 55 met inclusion criteria, with median follow up of 4.7 years (IQR 2.0–6.7). 58%(32/55) had no CS and, as expected, their median age at surgery than those with CS (9.3 vs 2.4 years, p<0.01). The indication for surgery was Ux alone in 46%(25/55) and primarily neurologic (Nx) in 38%(21/55) with CS present in 24%(6/25) and 62%(13/21), respectively. 16%(9/55) had no clinical symptoms but an abnormal MRI ordered due to CS (dermal sinus in 55%, 5/9). Median age at surgery for the Ux, Nx and no-symptom groups were 9.29, 8.65 and 1.21 years, respectively (ANOVA p<0.0001). In the Ux group, mean age at surgery with and without CS was 9 and 7.7 years (p=0.5). Fatty filum was the most common MRI diagnosis both overall (32/55, 58%), and in Ux patients (12/25, 64%). Early and late urologic outcomes for any symptomatic patient in Ux and Nx groups are shown in Table 1. Only subjective urinary symptoms showed a significant improvement. 21 patients with pre and postoperative ultrasounds had no clear improvement in hydronephrosis at last follow up. In the 13 patients with pre and postoperative UDS, detrusor overactivity was the only parameter that significantly improved at median follow up of 15.4 months (10 vs 3 patients, p<0.01). CONCLUSIONS Though Ux may be a common indication for neurosurgical intervention, in our series only subjective urinary symptoms and detrusor overactivity improved after surgery. These findings may help families establish realistic expectations about potential benefits of cord detethering for urologic findings in children with OSD. Table 1. Urologic Outcomes Preoperatively and at 3 and 12 Month Follow Up (N=46) Preoperative Early Follow Up Late Follow Up P value⁎ Subjective Urinary Symptoms 30 26 16 < 0.01 Urinary Incontinence 26 22 18 > 0.25 Constipation 19 15 17 > 0.69 Urinary Tract Infection 9 7 4 > 0.33 Clean Intermittent Catheterization 4 8 5 > 0.42 ⁎ Chi-Squared © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e194 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niki Kanaroglou Toronto, Canada More articles by this author Elias Wehbi Toronto, Canada More articles by this author Joseph M Gleason Toronto, Canada More articles by this author Reva Matta Beirut, Lebanon More articles by this author Joao Pippi Salle Toronto, Canada More articles by this author James Drake Toronto, Canada More articles by this author Sumit Dave London, Canada More articles by this author Armando Lorenzo Toronto, Canada More articles by this author Walid Farhat Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...