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A case of undiagnosed tethered cord syndrome aggravated by transurethral prostate resection
Sönke Boy1, André Reitz, Armin Curt
1Balgrist University Hospital, Swiss Paraplegic Center, Zürich, Switzerland. sboy@paralab.balgrist.ch
Background:
A 68-year-old man presented with a history of significant urinary urge incontinence, pollakiuria, and weak bladder sensation. He also reported mild fecal incontinence and a hypotrophic and slightly weaker left leg. At 63 years of age he had presented to a urologist for treatment of irritative lower urinary tract symptoms and incontinence. A transurethral resection of the prostate had been performed. After the operation, the symptoms had persisted and the incontinence seriously worsened.
Investigations:
Clinical neurologic examination, videourodynamic examination, neurophysiologic examination, and MRI of the spinal cord.
Diagnosis:
Neurogenic bladder dysfunction caused by adult tethered cord syndrome with myelon up to S2 level, spina bifida occulta, and lipoma infiltrating the conus medullaris.
Management:
Conservative anticholinergic treatment failed, and injection of botulinum-A toxin is planned.
