Urological outcome following multiple repeat spinal cord untethering operations. Clinical article

Area of Science:

• Pediatric Urology
• Neurosurgery
• Spinal Cord Medicine

Background:

• Spinal cord retethering is a complication following myelomeningocele or lipomyelomeningocele repair.
• Symptomatic retethering can lead to significant urological dysfunction in pediatric patients.
• Repeat untethering surgeries are sometimes necessary to address these complications.

Purpose of the Study:

• To evaluate the utility of urological testing in pediatric patients undergoing multiple repeat spinal cord untethering operations.
• To determine the correlation between urodynamic testing, sphincter electromyography, and clinical outcomes.
• To assess the effectiveness of surgical intervention for symptomatic retethering.

Main Methods:

• Retrospective review of 13 pediatric patients with myelomeningocele or lipomyelomeningocele who had at least two untethering procedures.
• Urodynamic testing, including slow-fill cystometrogram and external urethral sphincter electromyography, performed within 6 months pre- and post-operatively.
• Analysis of motor unit action potentials during various bladder filling and emptying phases.

Main Results:

• Seven out of 13 patients presented with new urinary symptoms prior to surgery.
• Five of these seven patients reported subjective improvement in urinary symptoms postoperatively.
• Improved bladder function on urodynamic testing correlated with symptomatic improvement, while sphincter electromyography did not.

Conclusions:

• Urodynamic testing is a valuable tool for selecting surgical candidates and evaluating outcomes in pediatric patients undergoing repeat spinal cord untethering.
• Sphincter electromyography findings showed no significant correlation with preoperative symptoms or postoperative improvement in this cohort.
• Bladder function assessment is more clinically relevant than sphincter electromyography for managing spinal cord retethering.