PTU - Polskie Towarzystwo Urologiczne
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CODE: 10.2 - Tethered cord syndrome: from urodynamics to neurosurgery
Article published in Urologia Polska 2006/59/Suplement 1.


Paweł Kroll, Krzysztof Strzyżewski, Andrzej Jankowski
Katedra Chirurgii Dziecięcej, Klinika Chirurgii i Traumatologii Dziecięcej AM w Poznaniu


Objectives. Analysis of neuro-urologic symptoms in children with tethered cord syndrome.
Materials and methods. The study comprised 42 children with tethered cord syndrome operated in our institution. 19 of them were boys, 23 girls, in age from 1 to 15 years. 12 of them had previously operated myelomeningocele, 13 lumbo-sacral lipoma, dysontogenetic tumor in 1 child, diplomyelia in 4, occult spinal dysraphism in 12. In all of them neuro-urologic examination with urodynamic investigations, x-rays of lumbo-sacral region and NMR-scans were performed.
Results. All children were operated because tethered cord syndrome had influence on symptoms of voiding or storage dysfunction. In cases of myelomeningocele children were previously managed because of known neurogenic bladder-sphincters dysfunction. In 12 cases neuro-urologic symptoms were the cause of further diagnostic procedures. From this group: 7 children were referred to our institution with secondary nocturnal enuresis, 5 with intractable OAB (overactive bladder syndrome). 6 of them had urge incontinence, 7 of them had also a history of recurrent urinary tract infections. In all of them pathology was found in urodynamic investigations. Further evaluation revealed anatomic pathology, spinal cord malformations, leading to surgery.
Conclusions. Neuro-urologic symptoms could be the first symptoms of tethered cord syndrome. A child with secondary nocturnal enuresis or secondary incontinence should be evaluated with the suspicion of neurogenic bladder dysfunction.