Urological Dysfunction Research Articles

The urinary-specific quality of life of multiple sclerosis patients: Dutch translation and validation of the SF-Qualiveen.

The SF-Qualiveen is a short questionnaire that measures the impact of urinary symptoms on the quality of life of patients with urological dysfunction due to neurological disorders. The aim of this study is to translate, culturally adapt and validate a Dutch version of the SF-Qualiveen for use in Multiple Sclerosis (MS) patients. Cross-cultural adaptation of the original English SF-Qualiveen into Dutch was performed according to standardized guidelines. Adult MS patients with symptomatic urinary disorders who visited the Urology or Rehabilitation outpatient clinic of the Erasmus Medical Center completed the SF-Qualiveen and the Urinary Distress Inventory-6 (UDI-6), that evaluates bother caused by lower urinary tract symptoms and was used as a gold standard, at baseline and 1-2 weeks later. A control group recruited from the Otolaryngology outpatient clinic completed the questionnaires once. Reliability and validity were determined. Fifty MS patients and 50 controls were included. SF-Qualiveen scores in patients were higher than in controls (on a scale of 0-4: 1.73 vs. 0.34; P < 0.001). Internal consistency (Cronbach's alpha >0.8) and reproducibility (Intraclass correlation coefficients >0.8) were good for the total SF-Qualiveen. Content validity was adequate and a significant relationship between SF-Qualiveen and UDI-6 (r = 0.510-0.479, P < 0.001) confirmed good criterion validity. The Dutch SF-Qualiveen showed good measurement properties. We recommend its use to measure urinary-specific quality of life in MS patients in research and clinical practice in the Netherlands.

Sacral extradural arachnoid cyst in association with split cord malformation

Background ContextSplit cord malformation (SCM) is a congenital disease that can be associated with other spinal anomalies. Few cases of concurrent intradural arachnoid cyst and SCM have been sporadically reported; however, sacral extradural arachnoid cyst (SEAC) with SCM is very rare. PurposeThe report describes our experience with simultaneous surgery in patients with concurrent SEAC and SCM in an effort to document the treatment of the rare spinal concomitant anomalies. Study DesignThe present study is designed as a case series. Patient SampleThis is a continuous series of patients with coexisting SCM and SEAC who were presented to our institution. Outcome MeasuresThe lower extremities weakness and deformity, radiological imaging, urodynamic tests, and surgical aspects of the patient population are documented. MethodsCases with concomitant anomalies were consecutively enrolled among 73 patients who were operated on for SCM between 2008 and 2014. Clinical data and surgical findings were prospectively filed and retrospectively evaluated. ResultsThere were seven patients (2 boys and 5 girls), with age ranging from 18 to 119 months (mean: 56.71±39.49). Type I SCM was detected in six cases, and type II SCM was detected in one case. Tethering of the cord was detected in all seven patients, and six patients (85.7%) had syrinx formation rostral to the level of SCM. All patients had at least one kind of urological dysfunctions manifesting as neurogenic bladder. On surgery, fistulous orifice of the meningeal cyst was found and ligated in six cases, and the other one was repaired via sealing the cyst walls as near as possible to the thecal sac. ConclusionsIn patients with symptomatic SCM, the signs of concurrent SEAC may be masqueraded by the former condition. It would be impossible to attribute a given sign, particularly urological signs, to either SCM or SEAC. Whatever the sign and nature, both conditions are better to be managed surgically in one session under a single anesthesia to prevent duplicate complications of further anesthesia and interventions in scar tissue.

MP74-17 IS UROLOGICAL DYSFUNCTIONS IN YOUNG WOMEN AN INHERITANCE OF CHILDHOOD?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I1 Apr 2016MP74-17 IS UROLOGICAL DYSFUNCTIONS IN YOUNG WOMEN AN INHERITANCE OF CHILDHOOD? Ester Illiano, Antonino Appignani, Kostantinos Giannitsas, Raffaele Balsamo, Antonella Giannantoni, Vincenzo Mirone, Franca Natale, Serena Mariuccia, Eleonora Salvini, Antonio Carbone, Antonio Pastore, Marianna Bevacqua, Marco Prestipino, Eugenia Fragalà, Maria Teresa Filocamo, Donata Villari, Vittorio Bini, and Elisabetta Costantini Ester IllianoEster Illiano More articles by this author , Antonino AppignaniAntonino Appignani More articles by this author , Kostantinos GiannitsasKostantinos Giannitsas More articles by this author , Raffaele BalsamoRaffaele Balsamo More articles by this author , Antonella GiannantoniAntonella Giannantoni More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Franca NataleFranca Natale More articles by this author , Serena MariucciaSerena Mariuccia More articles by this author , Eleonora SalviniEleonora Salvini More articles by this author , Antonio CarboneAntonio Carbone More articles by this author , Antonio PastoreAntonio Pastore More articles by this author , Marianna BevacquaMarianna Bevacqua More articles by this author , Marco PrestipinoMarco Prestipino More articles by this author , Eugenia FragalàEugenia Fragalà More articles by this author , Maria Teresa FilocamoMaria Teresa Filocamo More articles by this author , Donata VillariDonata Villari More articles by this author , Vittorio BiniVittorio Bini More articles by this author , and Elisabetta CostantiniElisabetta Costantini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1714AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES One of the most interesting area of research in urology is the correlation between childhood and adult lower urinary tract dysfunctions (LUTD). The aim of our study is to evaluate if the LUTD in women 18-40 years old, may be the result of previous pediatric LUTD. These results may identify the probable “risk conditions”. METHODS This is a multicenter prospective case-control study registered on the ClinicalTrials.gov (NCT02185287). Women referred to urological clinics were divided in 2 groups: healthy volunteer (group A) and patient (group B). Inclusion criteria were: age 18 to 40 years and any UD. Exclusion criteria were: diabetes mellitus, neurological disease, pelvic inflammatory disease, vaginal delivery =2 and baby with birth weight =4 kg. All women completed a self-administered 77-item questionnaire. It consists of 2 parts: I) explores the female urological and bowel history until the age of 14, II) refers to the current urological, bowel, and sexual history. Statistical analysis was performed using the non parametric Mann-Whitney U test and X2 test. P-value <0.05 was considered significant. RESULTS 254 women were enrolled, 134 in group A and 120 in the group B, both groups are comparable for demographic characteristics. The graph shows the percentage of LUTDs present in both groups in adult and pediatric age. Group A had fewer LUTDs in childhood than group B (27.6% vs 60% p=0.001). In the entire sample 73.6% of women with childhood episodes of urinary incontinence (UI) will be incontinent as adults (p<0.001); 68.7% of children with voiding symptoms will have them as adults (p<0.001), in particular 56.5% and 68% of girls who voided with straining and with interrupted flow respectively will develop a voiding dysfunction as adults (p<0.001). Increased urinary frequency (with more than 7 daytime voids) and urgency during childhood seem to be related to urinary frequency disturbances (p=0.04) and urgency symptoms (p=0.001) respectively in the adulthood. CONCLUSIONS LUTDs during childhood are correlated to LUTDs in adulthood, in fact adulthood voiding and storage symptoms and UI are significantly related to the presence of the same problems during the childhood. Girls with LUTDs should be carefully monitored to identify treatment or prevention strategy and confirming the need of a strict collaboration between pediatrics and urologists. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e976 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ester Illiano More articles by this author Antonino Appignani More articles by this author Kostantinos Giannitsas More articles by this author Raffaele Balsamo More articles by this author Antonella Giannantoni More articles by this author Vincenzo Mirone More articles by this author Franca Natale More articles by this author Serena Mariuccia More articles by this author Eleonora Salvini More articles by this author Antonio Carbone More articles by this author Antonio Pastore More articles by this author Marianna Bevacqua More articles by this author Marco Prestipino More articles by this author Eugenia Fragalà More articles by this author Maria Teresa Filocamo More articles by this author Donata Villari More articles by this author Vittorio Bini More articles by this author Elisabetta Costantini More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical Characteristics and Urodynamic Analysis of Urinary Dysfunction in Multiple Sclerosis.

Background:Both lower urinary tract dysfunction and urinary symptoms are prevalent in patients with multiple sclerosis (MS). Although the significance of identifying and treating urinary symptoms in MS is currently well-known, there is no information about the real prevalence and therapeutic effect of urinary symptoms in patients with MS. The purpose of this study was to analyze the major symptoms and urodynamic abnormalities, and observe the therapeutic effect in different MS characteristics.Methods:We enrolled 126 patients with urological dysfunction who were recruited between July 2008 and January 2015 in Beijing Tian Tan Hospital, Capital Medical University and conducted overactive bladder system score (OABSS), urodynamic investigation, and expanded disability status scale (EDSS). Changes of urinary symptoms and urodynamic parameters were investigated.Results:Urgency was the predominant urinary symptom, and detrusor overactivity was the major bladder dysfunction. There was a positive correlation between EDSS and OABSS. Clinically isolated syndrome (CIS) had lowest EDSS and OABSS. CIS exhibited significant improvements in OABSS, maximum urinary flow rate (Qmax), and bladder volume at the first desire to voiding and maximum bladder volume after the treatment (P < 0.05). Relapsing–remitting MS showed significant improvements in the OABSS, Qmax, and bladder volume at the first desire to voiding, maximum bladder volume and bladder compliance after the treatment (P < 0.05). Progressive MS exhibited significant increase in the bladder volume at the first desire to voiding, the detrusor pressure at maximum flow rate (PdetQmax), and bladder compliance after the treatment (P < 0.05).Conclusions:Urodynamic parameters examined are important in providing an accurate diagnosis, guiding management decisions of MS. Early and effective treatment may improve the bladder function and the quality of life at the early stages of MS.

1106 Urological dysfunctions in young women. “Is it an inheritance of childhood?”

1106 Urological dysfunctions in young women. “Is it an inheritance of childhood?”

Urogenital tract disorders in children suspected of being sexually abused.

IntroductionChild sexual abuse (CSA) is generally defined as child exploitation that leads to achievement of sexual satisfaction. According to data from European countries, sexual abuse of children affects 10–40% of girls and 5–20% of boys.Material and methodsThe Medline, and Web of Science databases were searched with no date limitation on May 2015 using the terms ‘child abuse’ in conjunction with ‘urinary tract’, ‘urologist’, ‘urological dysfunction’, ‘urologic symptoms’, ‘LUTS’ or ‘urinary infection’.ResultsAwareness of the CSA problem among paediatricians and urologists is very important, because they are often the only physicians who are able to recognize the problem. CSA diagnosis is possible only through the proper collection of a medical history and a thorough physical examination.Urologists have to remember that children exposed to sexual abuse rarely exhibit abnormal genital findings. In fact, absence of genital findings is the rule rather than the exception. In most cases, the final diagnosis of sexual abuse is based on the child's history and behavior, along with the onset and exacerbation of urologic symptoms.ConclusionsIn this article, we present a review of studies and literature concerning urinary symptoms in sexually abused children to clarify the problem for a broad group of urologists. We present common symptoms and premises that can point to the right diagnosis and basic guidelines of proceeding after suspicion of abuse.

Lethal Consequences in an Infant with Myelomeningocele Following an Inadvertent Treatment

Myelomeningocele (MMC) is a protrusion of spinal cord contents and meninges through a vertebral defect. Iatrogenic deaths of patients with MMC are rarely encountered in forensic practice. In our case, a 3-month-old female was born with a lumbosacral cyst, the size of which had been increasing gradually over age. There was no neurological, orthopedic, or urologic dysfunction. On the day of her death, she received a repetitive and rapid lumbosacral cyst puncture drainage procedure, performed by an illegal medical practitioner. Postmortem autopsy findings confirmed a diagnosis of MMC and the cause of death to be cerebellar tonsillar herniation. This is a pathetic case of preventable infant death. This report suggests that the possibility of MMC should be considered in infants born with a lumbosacral cyst, and aspiration is inadvisable. Besides, forensic autopsy has a valuable role in determining the exact cause of death, identifying, or excluding iatrogenic factors that may be relevant to death following a medical procedure. A final point is that prevention programs should be developed, especially by the health care sectors to reduce such tragedy.

Delivery of human mesenchymal adipose-derived stem cells restores multiple urological dysfunctions in a rat model mimicking radical prostatectomy damages through tissue-specific paracrine mechanisms.

Urinary incontinence (UI) and erectile dysfunction (ED) are the most common functional urological disorders and the main sequels of radical prostatectomy (RP) for prostate cancer. Mesenchymal stem cell (MSC) therapy holds promise for repairing tissue damage due to RP. Because animal studies accurately replicating post-RP clinical UI and ED are lacking, little is known about the mechanisms underlying the urological benefits of MSC in this setting. To determine whether and by which mechanisms MSC can repair damages to both striated urethral sphincter (SUS) and penis in the same animal, we delivered human multipotent adipose stem cells, used as MSC model, in an immunocompetent rat model replicating post-RP UI and ED. In this model, we demonstrated by using noninvasive methods in the same animal from day 7 to day 90 post-RP injury that MSC administration into both the SUS and the penis significantly improved urinary continence and erectile function. The regenerative effects of MSC therapy were not due to transdifferentiation and robust engraftment at injection sites. Rather, our results suggest that MSC benefits in both target organs may involve a paracrine process with not only soluble factor release by the MSC but also activation of the recipient's secretome. These two effects of MSC varied across target tissues and damaged-cell types. In conclusion, our work provides new insights into the regenerative properties of MSC and supports the ability of MSC from a single source to repair multiple types of damage, such as those seen after RP, in the same individual.

Pelvic floor symptoms in female cyclists and possible remedies: a narrative review.

Cycling has become a popular athletic activity worldwide and can lead to genital and pelvic floor dysfunction. This review summarizes the current body of evidence about the epidemiology of genital and pelvic floor symptoms in female cyclists, the therapy, and preventive interventions. Two electronic meta-databases, OvidSP™ and Deutsches Institut für Medizinische Dokumentation und Information (DIMDI), comprising 40 individual databases, were searched for studies that described genital and pelvic floor symptoms in association with cycling and studies that tested possible therapies and prophylactic measures. For the literature search we explored the search terms "female", "bicycling", "pelvic floor", "lower urinary tract symptoms", and "vulvar diseases". The search retrieved 1,219 articles, leaving 763 articles after removal of duplicates, and finally 12 articles eligible for review. We assessed 10 observational and 2 experimental studies. Genital and pelvic floor symptoms related to bicycling were pain, tenderness, neuropathy, urological dysfunction and skin lesions. Broader and conventionally shaped saddles were associated with fewer symptoms compared with cut-out saddle designs. The quality of existing studies is generally low, but there is evidence that female cyclists suffer from similar problems to male cyclists, ranging from minor skin lesions to severe sequelae such as pain and neurological deficiencies.

Utility of urodynamics in the management of asymptomatic tethered cord in children.

We have noted a recent increase in neurosurgical requests at our institution for urodynamics (UDS) prior to release of asymptomatic tethered cord. Our aim was to determine how preoperative UDS results are used in the clinical management of asymptomatic tethered cord. A retrospective review was performed of 120 patients diagnosed with primary tethered cord from 2007 to 2010. Inclusion criteria included MRI diagnosis of tethered cord and UDS performed by three pediatric urologists. Excluded were any neurologic or urologic dysfunction or associated syndromes, as well as other significant comorbidities. Thirty-eight patients (female 26; male 12), mean age of 3 years (0.2-16.3) were diagnosed with an asymptomatic tethered cord. The majority of the patients had normal preoperative renal ultrasounds. Thirty-one (82 %) of the children had normal baseline UDS, yet twenty-one (68 %) of these patients still underwent neurosurgical intervention. Of the 27 patients untethered, 15 patients (55 %) had follow-up UDS performed. Three patients had improved UDS parameters and one had worsening UDS parameters, including high PVR and DSD. Of the seven patients with abnormal baseline UDS, all had normal renal ultrasound findings and had no other significant differences in presentation from the patients with normal UDS. In children with asymptomatic tethered cord, abnormal preoperative UDS may prompt intervention, while normal UDS do not appear to prevent intervention. There is no significant correlation between abnormal preoperative UDS and abnormal preoperative imaging. Further study is needed to evaluate the utility of this procedure in the preoperative setting in this asymptomatic patient population.

Prevalence of scoliosis in Williams-Beuren syndrome patients treated at a regional reference center

OBJECTIVE:This study assessed the prevalence of scoliosis and the patterns of scoliotic curves in patients with Williams-Beuren syndrome. Williams-Beuren syndrome is caused by a chromosome 7q11.23 deletion in a region containing 28 genes, with the gene encoding elastin situated approximately at the midpoint of the deletion. Mutation of the elastin gene leads to phenotypic changes in patients, including neurodevelopmental impairment of varying degrees, characteristic facies, cardiovascular abnormalities, hypercalcemia, urological dysfunctions, and bone and joint dysfunctions.METHODS:A total of 41 patients diagnosed with Williams-Beuren syndrome, who were followed up at the genetics ambulatory center of a large referral hospital, were included in the study. There were 25 male subjects. The patients were examined and submitted to radiographic investigation for Cobb angle calculation.RESULTS:It was observed that 14 patients had scoliosis; of these 14 patients, 10 were male. The pattern of deformity in younger patients was that of flexible and simple curves, although adults presented with double and triple curves. Statistical analysis showed no relationships between scoliosis and age or sex.CONCLUSION:This study revealed a prevalence of scoliosis in patients with Williams-Beuren syndrome of 34.1%; however, age and sex were not significantly associated with scoliosis or with the severity of the curves.

Isolation, culture, and transplantation of muscle satellite cells.

Muscle satellite cells are a stem cell population required for postnatal skeletal muscle development and regeneration, accounting for 2-5% of sublaminal nuclei in muscle fibers. In adult muscle, satellite cells are normally mitotically quiescent. Following injury, however, satellite cells initiate cellular proliferation to produce myoblasts, their progenies, to mediate the regeneration of muscle. Transplantation of satellite cell-derived myoblasts has been widely studied as a possible therapy for several regenerative diseases including muscular dystrophy, heart failure, and urological dysfunction. Myoblast transplantation into dystrophic skeletal muscle, infarcted heart, and dysfunctioning urinary ducts has shown that engrafted myoblasts can differentiate into muscle fibers in the host tissues and display partial functional improvement in these diseases. Therefore, the development of efficient purification methods of quiescent satellite cells from skeletal muscle, as well as the establishment of satellite cell-derived myoblast cultures and transplantation methods for myoblasts, are essential for understanding the molecular mechanisms behind satellite cell self-renewal, activation, and differentiation. Additionally, the development of cell-based therapies for muscular dystrophy and other regenerative diseases are also dependent upon these factors. However, current prospective purification methods of quiescent satellite cells require the use of expensive fluorescence-activated cell sorting (FACS) machines. Here, we present a new method for the rapid, economical, and reliable purification of quiescent satellite cells from adult mouse skeletal muscle by enzymatic dissociation followed by magnetic-activated cell sorting (MACS). Following isolation of pure quiescent satellite cells, these cells can be cultured to obtain large numbers of myoblasts after several passages. These freshly isolated quiescent satellite cells or ex vivo expanded myoblasts can be transplanted into cardiotoxin (CTX)-induced regenerating mouse skeletal muscle to examine the contribution of donor-derived cells to regenerating muscle fibers, as well as to satellite cell compartments for the examination of self-renewal activities.

Isolation, Culture, and Transplantation of Muscle Satellite Cells

Muscle satellite cells are a stem cell population required for postnatal skeletal muscle development and regeneration, accounting for 2-5% of sublaminal nuclei in muscle fibers. In adult muscle, satellite cells are normally mitotically quiescent. Following injury, however, satellite cells initiate cellular proliferation to produce myoblasts, their progenies, to mediate the regeneration of muscle. Transplantation of satellite cell-derived myoblasts has been widely studied as a possible therapy for several regenerative diseases including muscular dystrophy, heart failure, and urological dysfunction. Myoblast transplantation into dystrophic skeletal muscle, infarcted heart, and dysfunctioning urinary ducts has shown that engrafted myoblasts can differentiate into muscle fibers in the host tissues and display partial functional improvement in these diseases. Therefore, the development of efficient purification methods of quiescent satellite cells from skeletal muscle, as well as the establishment of satellite cell-derived myoblast cultures and transplantation methods for myoblasts, are essential for understanding the molecular mechanisms behind satellite cell self-renewal, activation, and differentiation. Additionally, the development of cell-based therapies for muscular dystrophy and other regenerative diseases are also dependent upon these factors. However, current prospective purification methods of quiescent satellite cells require the use of expensive fluorescence-activated cell sorting (FACS) machines. Here, we present a new method for the rapid, economical, and reliable purification of quiescent satellite cells from adult mouse skeletal muscle by enzymatic dissociation followed by magnetic-activated cell sorting (MACS). Following isolation of pure quiescent satellite cells, these cells can be cultured to obtain large numbers of myoblasts after several passages. These freshly isolated quiescent satellite cells or ex vivo expanded myoblasts can be transplanted into cardiotoxin (CTX)-induced regenerating mouse skeletal muscle to examine the contribution of donor-derived cells to regenerating muscle fibers, as well as to satellite cell compartments for the examination of self-renewal activities.

Spontaneous improvement in urological dysfunction in children with congenital spinal lipomas of the conus medullaris

Congenital spinal lipomas of the conus (SLCs) are among the most common closed neural tube defects. The treatment of SLC is an area of controversy because the true natural history of this condition is unknown. Here, the authors present two cases of SLC presenting in infancy with compromised lower urinary tract function, which was objectively confirmed by abnormal urodynamic studies. In both cases, there was spontaneous improvement in urodynamic parameters, with stable normal urinary function at the long-term follow-up. Although cases of spontaneous radiological regression of SLC have very infrequently been reported, they have not been associated with the reversal of already present neurological deficits. This report reinforces the need for further delineation of the true natural history of SLC and highlights the dynamic nature of associated neurological compromise over time.

Urodynamics for Spinal Cord Injury – How, When, Why

Patients with spinal cord injury (SCI) often have lower urinary tract dysfunction. Their urological dysfunction should be managed as part of their overall holistic care in a specialist SCI unit. Whilst level of disease can cause broad categories of urological problems, lower urinary tract symptoms may be complex and difficult. Urodynamic studies investigate the urinary tract by measurement of flow and pressure. Urodynamic studies perform an important role in the urological management of patients with SCI. Invasive video urodynamic studies are the gold standard urodynamics of choice in these patients due to the extra information that can be gleaned from fluoroscopy. The major complication of neurogenic lower urinary tract dysfunction is of a risk to the upper tracts. Baseline urodynamic studies are performed in patients with SCI to assess symptoms and risk to the upper tracts, so that management can be planned accordingly. The optimum follow-up schedule for urodynamics remains controversial.

Thoraco-Lumbar Junction Disc Herniation and Tight Filum: A Unique Combination?

Purpose: The incidence of both symptomatic thoraco-lumbar junction disc herniation (TLJDH) and tight filum (TF) may be underestimated. Both conditions have a complex clinical presentation that may involve the distal spinal cord, conus medullaris, and/or cauda equina, including upper and/or lower motor neuron impairment, sensory impairment, urological and sexual dysfunction. The coexistence of both conditions has not been previously reported and may be a diagnostic and therapeutic challenge. Methods: We report three teenage girls, a 24-year-old woman, and two middle-aged women who were diagnosed with both conditions and treated at our institution. Results: Disc herniation level was T11-T12 in 2, T12-L1 in 3, and L1-L2 in one. All patients had a fatty filum (n = 5) and/or a low-lying CM (at or above L1-L2 in 2, at or below L2-L3 in 4), and were treated with filum sectioning first. All patients noted marked improvement of preoperative complaints including back pain (n = 5), leg pain and fatigue (n = 4), urological complaints (n = 4), and toe gait (n = 1). One 16-year-old girl successfully underwent a thoracoscopic microdiscectomy for persisting pain at the thoraco-lumbar junction two years after filum sectioning. Conclusions: Thoraco-lumbar junction disc herniation and tight filum both act on the distal spinal cord close to the transition to the cauda equina. Both conditions may coincide and may even act synergistically, the disc herniation acting as a fulcrum, aggravating the deleterious effect of the tethering force (and vice versa). This might explain why both conditions combined may present at a younger age. We suggest filum sectioning as the primary treatment option in all patients, however, more cases and a longer follow-up are needed to better understand their unique combination and interaction. Nevertheless, when confronted with a symptomatic TLJDH especially in young patients we advise to rule out a coinciding TF by careful consideration of all clinical, radiological, and urological data.

Urologic and anorectal complications of sacrococcygeal teratomas: Prenatal and postnatal predictors

PurposeAnorectal and urologic sequelae are observed in long-term survivors of sacrococcygeal teratoma (SCT). In this study we evaluate the incidence and predictors of anorectal and urologic complications in SCT. MethodsA retrospective review was performed for all SCT patients who underwent resection at a single institution between 2000 and 2012. Enrollment criteria included a minimum of 12months follow-up. Categorical variables were analyzed by Fisher’s exact test and continuous variables by Mann Whitney test (p<0.05). ResultsForty-five patients were studied. Anorectal complications occurred in 29%, including severe chronic constipation (n=13) and fecal incontinence (n=4). Urologic complications occurred in 33%, including neurogenic bladder (n=12), vesicoureteral reflux (n=5), and urinary incontinence (n=7). Prenatal imaging by fetal MRI demonstrated mass effect with obstruction of the bowel (n=4) or bladder and collecting system (n=7) in a subset of patients with postnatal complications (anorectal 4/4, PPV 100%; urologic 6/7, PPV 86%). Postnatal complications were associated with obstructive findings on prenatal imaging, prenatal therapeutic interventions, Altman classification, perineal reconstruction, and tumor recurrence. No anorectal or urologic complications occurred in patients with Altman type I tumors. ConclusionsUrologic and anorectal complications are common in patients with SCT. Higher Altman classification and prenatal imaging suggestive of intestinal or urologic obstruction should prompt focused prenatal counseling and postnatal screening for anorectal and urologic dysfunction.

Diastematomyelia Presenting in Adulthood as Back Pain

A 27-yr-old woman presented with a 4-yr history of postpartum low back pain and 1 yr of vague leg dysesthesias. Her pain had limited both function and ambulation, and she complained of increasing urinary tract infections, urgency, and constipation. Her other medical conditions included spina bifida occulta, congenital scoliosis, childhood thoracic fusion, high-arched feet, unicorn uterus, and solitary kidney, ovary, and fallopian tube. She demonstrated lumbar midline hypertrichosis and thoracic levoscoliosis. Her bilateral lower limb strength was 5/5 with asymmetric high-arched feet. Reflexes were 3+ on right and 2+ on left patella and 2+ at bilateral achilles tendons. Her sensation to light touch and temperature was intact, and her gait pattern was normal. Plain x-rays showed bifid L3 and L4. Noncontrast magnetic resonance imaging demonstrated an L2–L5 spinal dysraphism and split spinal cord (Fig. 1) rejoining at L3 with tethering into fatty filum terminale. She underwent tethered cord release and laminectomy.FIGURE 1: Magnetic resonance lumbar spine axial T2 fat suppression image showing split cord (arrow).On 1-mo surgical follow-up, her “sharp” lumbar back pain near the surgical site persisted with bilateral thigh/knee numbness and urinary incontinence; she ambulated with a walker. Examination showed diminished sensation to light touch at her quadriceps and hamstrings, intact pinprick sensation, reflexes 2+/4, and no focal weakness. Diastematomyelia is a dysraphism with an osseous, cartilaginous, or fibrous septum bifurcating the spinal cord.1 Spinal cord malformations often associate with other cord/column anomalies, including tethered cord syndrome and scoliosis.1 Tethered cord syndrome is a stretch-induced disorder with caudal anchoring by an inelastic structure.2 Adult presentation is uncommon and can be misdiagnosed as lumbar degenerative disease because of subtle, nonspecific findings. The degree of cord traction, not the tethering level or origin, is critical. Typically, patients present with pain, weakness, and urologic dysfunction.2 Acute symptoms may follow lumbar spinal trauma (pregnancy, childbirth, exercise, etc.) with filar fibrosis. Enhanced lumbosacral ligamentous laxity with childbirth can stretch the conus.3 Adults with spina bifida may experience more pain and sphincter dysfunction with lumbosacral motion.3 Magnetic resonance imaging is preferred for diagnosis. Surgery is the most common treatment. Timing and recommendations are controversial; most advocate surgery only after neurologic deterioration. Deficits may remain or even worsen from surgery.3

Retethering in Children after Sectioning of the Filum Terminale

Background/Aim: Sectioning of the filum terminale is performed when spinal cord tethering is suspected, sometimes without clinical symptoms. Retethering can occur and require reoperation due to the presentation of either recurrent or new symptoms. The purpose of this institutional review was to identify the retethering rate in children, especially in those who were initially asymptomatic, and to discuss the role of surgery. Methods: The medical records of all children at the Children's Hospital of Eastern Ontario (CHEO) who underwent tethered cord surgery between 1978 and 2009 for a thickened filum terminale were retrospectively reviewed, as well as those who retethered. Results: A total of 146 patients with a mean age of 4.3 years underwent a low lumbar single or partial laminectomy for sectioning of the filum terminale; 44 patients (30.1%) were asymptomatic at the time of surgery, 51.4% had bladder and bowel dysfunction, 26.7% had neuroorthopedic findings, 15.8% had pain and 6.2% had progressive scoliosis; 11 children with a median age of 8.9 years had symptoms of retethering requiring reoperation (median time to retether was 4.3 years) and 4 were initially asymptomatic. Repeat surgery was successful at alleviating the new symptoms that occurred as a result of retethering. Conclusions: Of the 146 patients at CHEO who underwent surgery, 7.5% retethered, with 36% being initially asymptomatic. Those operated in the first year of life were not found to be at a higher risk. The level of the conus medullaris did not influence the rate or retethering or urological dysfunction. Children who were initially asymptomatic improved after surgery for retethering, but may not have required surgery in the first place.

Dysautonomie et troubles urinaires au cours de la sclérose en plaques. Étude clinique, urodynamique et cardiovasculaire

To assess symptoms related to autonomic nervous system alteration in a population of patients suffering from multiple sclerosis (MS) and presenting with urinary symptoms. We investigated 65 patients (mean age 47.5 years) suffering from MS, and presenting with urological dysfunction by means of symptom scores, urodynamic investigation, cardiovascular autonomic function tests (orthostatic hypotension testing, Valsalva test, deep breath test, cold pressor test) and sympathetic skin responses. Forty-five (69%) patients suffered from overactive bladder, 48 (73%) from voiding dysfunction, 14 (21%) from urinary retention and 13 (20%) from fecal incontinence. Urodynamic investigation demonstrated overactive detrusor in 46 (70%) cases, and underactive detrusor in four (6%) cases. Twenty-five (38%) patients had dysautonomia without correlation neither with clinical or urodynamic data, nor gravity of multiple sclerosis (EDSS). In this series, the prevalence of dysautonomia was high in patients suffering from MS and presenting with urinary disorders.