MP52-08 LOWER URINARY TRACT FUNCTION PRE- AND POST-UNTETHERING SURGERY FOR SECONDARY TETHERING IN PATIENTS WITH SPINA BIFIDA

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP52-08 LOWER URINARY TRACT FUNCTION PRE- AND POST-UNTETHERING SURGERY FOR SECONDARY TETHERING IN PATIENTS WITH SPINA BIFIDA Daisuke Gotoh, Kenta Onishi, Yosuke Morizawa, Shunta Hori, Yasushi Nakai, Makito Miyake, Kazumasa Torimoto, and Fujimoto Kiyohide Daisuke GotohDaisuke Gotoh More articles by this author , Kenta OnishiKenta Onishi More articles by this author , Yosuke MorizawaYosuke Morizawa More articles by this author , Shunta HoriShunta Hori More articles by this author , Yasushi NakaiYasushi Nakai More articles by this author , Makito MiyakeMakito Miyake More articles by this author , Kazumasa TorimotoKazumasa Torimoto More articles by this author , and Fujimoto KiyohideFujimoto Kiyohide More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Secondary tethering of the spinal cord occurs in 3–30% of patients with history of spinal cord repair of spina bifida. Tethered spinal cord syndrome is characterized by neuropathy that develops when the caudal end of the spinal cord is fixed and gets pulled as the spine grows. These patients show various symptoms of lower urinary tract dysfunction, including urinary incontinence, frequent urination, and dysuria. The main treatment is surgical release of the tethered spinal cord. We evaluated the effect of spinal cord untethering surgery on lower urinary tract dysfunction for secondary tethered spinal cord. METHODS: We enrolled patients with spinal cord retethering who underwent untethering surgery at the Department of Urology, Nara Medical University and Hoshigaoka Medical Center between January 1, 2010, and December 31, 2021. We retrospectively evaluated pre- and 6 months postoperative video-urodynamic findings of detrusor overactivity (DO), vesicoureteral reflux (VUR), bladder deformity (BD), maximum cystometric capacity (MCC), MCC/expected bladder capacity (EBC), and bladder compliance. RESULTS: Median age at retethering of the 19 participants included was 9 years. Nine patients had myelomeningocele and 10 had a spinal lipoma. Seventeen patients were managed with self-catheterization. DO was observed in six patients; it disappeared postoperatively in all of them. VUR was observed in three patients, and the severity reduced after surgery in two of them. The Ogawa classification grade of BD improved postoperatively in six patients (Figure 1). Marked postoperative improvement was also noted in MCC, MCC/EBC, and bladder compliance (pre- vs. postoperative MCC: 172.1±86.7 vs. 231.3±108.9 mL, p<0.0001; MCC/EBC: 63.8±27.3 vs. 72.7±28.4%, p=0.0131; and compliance: 9.1±8.6 vs. 13.7±12.8 mL/cm H2O, p=0.0098) (Figure 2). CONCLUSIONS: Release of the retethered spinal cord after primary repair improved urine storage function as assessed using video-urodynamics in patients with spina bifida. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e705 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daisuke Gotoh More articles by this author Kenta Onishi More articles by this author Yosuke Morizawa More articles by this author Shunta Hori More articles by this author Yasushi Nakai More articles by this author Makito Miyake More articles by this author Kazumasa Torimoto More articles by this author Fujimoto Kiyohide More articles by this author Expand All Advertisement PDF downloadLoading ...