Bladder function before and after selective dorsal rhizotomy in children with cerebral palsy

Area of Science:

• Pediatric Urology
• Neurology
• Rehabilitation Medicine

Background:

• Children with cerebral palsy (CP) often experience dysfunctional voiding symptoms.
• Selective dorsal rhizotomy (SDR) is a surgical procedure for managing lower extremity spasticity in CP.
• SDR may impact bladder function, necessitating further investigation.

Purpose of the Study:

• To evaluate the effect of SDR on bladder function in children with CP.
• To compare preoperative and postoperative voiding symptoms and urodynamic parameters.
• To assess the correlation between SDR and improvements in bladder storage characteristics.

Main Methods:

• Retrospective review of urodynamic studies in 40 children (25 boys, 15 girls) who underwent SDR.
• Urodynamic assessments were performed preoperatively and/or postoperatively.
• Surgical intervention involved SDR for spasticity management.

Main Results:

• Preoperative urodynamic studies revealed abnormal bladder capacity and pressure in 65.7% of patients, many asymptomatic.
• SDR significantly improved total bladder capacity (p <0.005) and pressure-specific volumes (p <0.005).
• Postoperative outcomes included neurological improvement, increased continence rates (5/7), and no urodynamic deterioration.

Conclusions:

• A significant proportion of children with spastic CP have subclinical bladder dysfunction.
• SDR effectively improves both spasticity and bladder storage capacity.
• Pre-SDR urodynamic evaluation is recommended for children with CP undergoing surgery for lower limb spasticity.