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[Urodynamic studies on the untethering of spinal lipoma in the children]
K Wada1, K Morimoto, O Takemoto
1Department of Neurosurgery, Osaka Medical Center, Japan.
Insights
Spinal lipoma in children often presents with urinary issues. Early diagnosis and treatment are crucial for managing potential urological complications and improving outcomes.
Area of Science:
- Pediatric Urology
- Neurosurgery
- Developmental Biology
Background:
- Spinal lipomas are congenital tumors that can cause neurological deficits.
- Urological dysfunction is a known complication associated with spinal dysraphism.
Purpose of the Study:
- To evaluate the prevalence and nature of urological findings in children with spinal lipoma.
- To assess the impact of conus untethering surgery on urinary function in this patient population.
Main Methods:
- Retrospective analysis of 36 children with spinal lipoma undergoing conus untethering.
- Review of preoperative and postoperative urological examinations including ultrasonography, voiding cystourethrography (VCG), and urodynamic cystometry.
Main Results:
- 60% of patients had no preoperative urinary dysfunction or abnormalities.
- 23.3% had abnormal vesicoureteral reflux (VUR) preoperatively, which resolved or improved post-surgery.
- 2 patients required clean intermittent self-catheterization postoperatively.
Conclusions:
- Children with spinal lipoma have a significant likelihood of presenting with urological findings.
- Early diagnosis and timely intervention are essential for managing urological complications in spinal lipoma patients.
Abstract:
We performed conus untethering on 44 children with spinal lipoma. In this retrospective study, we studied urological examinations obtained in 36 consecutive patients. Urological examinations were ultrasonography of bladder and kidney, voiding cystourethrography (VCG), and urodynamic cystometry. In those of them, 6 patients had already had urinary dysfunction at preoperative stage, but 4 patients' spinal lipoma was one complication of cloaca exstrophy and 2 patients' spinal lipoma after repairment of their myelomeningocele. In the remaining 30 cases, 18 patients (60.0%) as the group 1 did not have urinary dysfunction and abnormality in any urological examinations. Another 7 patients (23.3%) as group 2 also did not have urinary dysfunction, but abnormal vesicoureteral reflux (VUR) was found out in their VCG examination. At postoperative stage, abnormal VUR resolved or improved in all these 7 cases, but one of them showed transient urinary retention. Two patients of 18 in the group 1 had to require clean intermittent self-catheterization at postoperative stage. These observations confirmed that children with spinal lipoma were more likely to present with urological findings, and so it was imperative that a diagnosis be made and treatment be instituted as early as possible.