Intraoperative rectal ampullar manometry in spinal cord conus lipoma surgery in children

Abstract

Objective . To assess a potential of using intraoperative rectal ampullar manometry to prevent bladder dysfunction in surgical treatment of the spinal cord conus lipoma. Material and Methods . The results of surgical treatment of 59 children with lipomas of the spinal cord conus were studied. The presence of urological symptoms (urinary retention or incontinence) was assessed before and after surgery. Intraoperative rectal ampullar manometry was performed in 22 cases with registration of signs of irritation (increased pressure in the rectal ampulla) and depression (decreased pressure in the rectal ampulla) of sacral parasympathetic centers which allowed controlling their proximity and tolerance to the performed manipulations. Results . Urological symptoms before surgery were detected in 25 (42 %) patients: urinary retention in 7 (28 %), and incontinence in 18 (72 %). Symptoms were significantly more often detected in children older than 3 years (p 3 mm Hg) have precluded from the total removal of lipoma in all 22 patients; subtotal or partial lipoma removal and release of the tethered spinal cord were achieved in all cases. None of the patients operated on using rectal ampullar manometry presented urinary retention after surgery, these disorders developed in 12 (32 %) children operated on without this procedure (p < 0.05). Conclusion . Paresis or paralysis of the bladder detrusor after removal of the spinal cord conus lipoma may result from direct damage to the parasympathetic sacral centers located at the borderline between the lipoma and the spinal cord. The method of intraoperative rectal ampullar manometry allows protecting the functions of the pelvic organs and determining the safe volume of lipoma resection.