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Treatment of the occult tethered spinal cord for neuropathic bladder: results of sectioning the filum terminale.
J Urol. 2006 Oct; 176(4 Pt 2):1826-9; discussion 1830.JU

Abstract

PURPOSE

Occult tethered cord syndrome applies to patients with signs and symptoms consistent with a caudal spinal cord malformation despite normal neuroimaging. Although several reports of successful surgical treatment exist, controversy remains with respect to patient selection and efficacy. We present a large series with excellent clinical followup, neuroimaging and urodynamic characterization.

MATERIALS AND METHODS

We present our experience with 36 patients at a single institution with preoperative clinical findings, neuroimaging and urodynamics available. Postoperative outcomes were assessed clinically and with urodynamics. We determined predictive parameters to improve patient selection.

RESULTS

Approximately 0.04% of pediatric urology clinic visits resulted in neurosurgical referral for the potential of an occult tethered cord. They occurred after failure of a mean of 2 years of aggressive medical management. Daytime urinary incontinence was present in 83% of patients and 47% had encopresis. Preoperative urodynamics were markedly abnormal in all patients with mean bladder capacity 55% of expected capacity. Clinical improvement in urinary symptoms was seen in 72% of patients with resolution of incontinence in 42%. Bowel symptoms improved in 88% of cases, including resolution of encopresis in 53% within 3 months of surgery. Urodynamic improvements were demonstrated in 57% of cases. We were unable to determine preoperative factors that were more likely associated with surgical success.

CONCLUSIONS

In a highly select population with severe urinary and fecal dysfunction sectioning a normal-appearing filum terminale can result in significant improvement. We were unable to identify factors that may increase the chance of surgical success.

Authors+Show Affiliations

Department of Pediatric Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, 702 North Barnhill Drive, Indianapolis, IN 46202, USA. pmetcalf@iupui.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16945660

Citation

Metcalfe, P D., et al. "Treatment of the Occult Tethered Spinal Cord for Neuropathic Bladder: Results of Sectioning the Filum Terminale." The Journal of Urology, vol. 176, no. 4 Pt 2, 2006, pp. 1826-9; discussion 1830.
Metcalfe PD, Luerssen TG, King SJ, et al. Treatment of the occult tethered spinal cord for neuropathic bladder: results of sectioning the filum terminale. J Urol. 2006;176(4 Pt 2):1826-9; discussion 1830.
Metcalfe, P. D., Luerssen, T. G., King, S. J., Kaefer, M., Meldrum, K. K., Cain, M. P., Rink, R. C., & Casale, A. J. (2006). Treatment of the occult tethered spinal cord for neuropathic bladder: results of sectioning the filum terminale. The Journal of Urology, 176(4 Pt 2), 1826-9; discussion 1830.
Metcalfe PD, et al. Treatment of the Occult Tethered Spinal Cord for Neuropathic Bladder: Results of Sectioning the Filum Terminale. J Urol. 2006;176(4 Pt 2):1826-9; discussion 1830. PubMed PMID: 16945660.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of the occult tethered spinal cord for neuropathic bladder: results of sectioning the filum terminale. AU - Metcalfe,P D, AU - Luerssen,T G, AU - King,S J, AU - Kaefer,M, AU - Meldrum,K K, AU - Cain,M P, AU - Rink,R C, AU - Casale,A J, PY - 2006/02/08/received PY - 2006/9/2/pubmed PY - 2006/10/13/medline PY - 2006/9/2/entrez SP - 1826-9; discussion 1830 JF - The Journal of urology JO - J. Urol. VL - 176 IS - 4 Pt 2 N2 - PURPOSE: Occult tethered cord syndrome applies to patients with signs and symptoms consistent with a caudal spinal cord malformation despite normal neuroimaging. Although several reports of successful surgical treatment exist, controversy remains with respect to patient selection and efficacy. We present a large series with excellent clinical followup, neuroimaging and urodynamic characterization. MATERIALS AND METHODS: We present our experience with 36 patients at a single institution with preoperative clinical findings, neuroimaging and urodynamics available. Postoperative outcomes were assessed clinically and with urodynamics. We determined predictive parameters to improve patient selection. RESULTS: Approximately 0.04% of pediatric urology clinic visits resulted in neurosurgical referral for the potential of an occult tethered cord. They occurred after failure of a mean of 2 years of aggressive medical management. Daytime urinary incontinence was present in 83% of patients and 47% had encopresis. Preoperative urodynamics were markedly abnormal in all patients with mean bladder capacity 55% of expected capacity. Clinical improvement in urinary symptoms was seen in 72% of patients with resolution of incontinence in 42%. Bowel symptoms improved in 88% of cases, including resolution of encopresis in 53% within 3 months of surgery. Urodynamic improvements were demonstrated in 57% of cases. We were unable to determine preoperative factors that were more likely associated with surgical success. CONCLUSIONS: In a highly select population with severe urinary and fecal dysfunction sectioning a normal-appearing filum terminale can result in significant improvement. We were unable to identify factors that may increase the chance of surgical success. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/16945660/Treatment_of_the_occult_tethered_spinal_cord_for_neuropathic_bladder:_results_of_sectioning_the_filum_terminale_ L2 - https://www.jurology.com/doi/full/10.1016/j.juro.2006.04.090?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -