Study of Tethered Spinal Cord Syndrome Diagnosis Following a Close Examination of Daytime Urinary Incontinence

Abstract

Background: Tethered spinal cord syndrome refers to neurological disorders caused by the lower end of the spinal cord becoming entrapped in the caudal tissue. Dysuria is one of the most common symptoms and often appears at an early stage. In this study, we investigated cases of children with tethered spinal cord syndrome who were presented to the urology department with daytime urinary incontinence. Subjects and methods: Eighteen children with tethered spinal cord syndrome were diagnosed between March 2011 and October 2017 after a visit to the urology department with daytime urinary incontinence as the main complaint. The reasons for the diagnosis of tethered spinal cord syndrome and the changes in clinical symptoms before and after laminectomy were investigated. Results: Nine boys and nine girls were selected as the study subject. The mean age at the first examination was 6.3 years (range 4–9 years). All patients underwent urodynamics and voiding cystourethrogram (VCUG) for refractory daytime urinary incontinence. Spinal MRI was performed in all patients to investigate abnormal findings on VCUG and urodynamics. Only four patients had indications of tethered spinal cord syndrome on MRI. Eight patients had lipoma of the filum terminale, four patients had potential tethered spinal cord syndrome, four patients had low-lying conus, one patient with conus lipoma, and one patient had intrasacral meningeal cyst. The mean follow-up after laminectomy was 66.3 (22–116) months, 11 patients were asymptomatic, 4 patients had residual nocturia only, and 3 patients were managed with intermittent voiding. Conclusion: It is necessary to treat patients with daytime urinary incontinence is one of the symptoms of the tethered spinal cord syndrome. Bladder function assessed by urodynamics may provide a diagnostic sign for spinal cord compression.