Central nervous system lesion causing urethral instability and urinary incontinence.

Area of Science:

• Neurology
• Urology
• Pediatric Surgery

Background:

• Cerebral arteriovenous fistulas (cAVFs) are rare, complex vascular malformations.
• Surgical intervention for cAVFs can carry risks of neurological and functional complications.
• Post-surgical urinary incontinence is an uncommon but significant complication.

Observation:

• A pediatric patient developed urinary incontinence following surgical repair of a cAVF.
• Urodynamic studies revealed intermittent decreases in urethral pressure and external anal sphincter (EAS) electromyographic (EMG) activity.
• These episodes correlated with radiographic contrast material entering the urethra, indicating a reflux mechanism.

Findings:

• The patient's urinary incontinence was linked to urethral pressure fluctuations and EAS deactivation.
• Treatment with ephedrine sulfate effectively prevented urine entry into the proximal urethra.
• Complete daytime continence was achieved with ephedrine sulfate, resolving the primary symptom.

Implications:

• Ephedrine sulfate may be a viable treatment for specific types of post-surgical urinary incontinence.
• This case highlights the importance of urodynamic evaluation in diagnosing complex incontinence.
• Understanding the neuro-urological interplay is crucial for managing post-surgical complications in pediatric patients.