Tags

Type your tag names separated by a space and hit enter

Filum Section for Urinary Incontinence in Children with Occult Tethered Cord Syndrome: A Randomized, Controlled Pilot Study.
J Urol. 2016 Apr; 195(4 Pt 2):1183-8.JU

Abstract

PURPOSE

Occult tethered cord syndrome, in which there is normal neuroanatomic imaging despite clinical and urodynamic evidence of neuropathic bladder behavior, is controversial. Several uncontrolled series describe improvement in bladder function following section of the filum terminale. We performed a pilot randomized, controlled study comparing medical treatment to surgical section of the filum plus medical treatment in children with occult tethered cord syndrome.

MATERIALS AND METHODS

Children refractory to standard medical management for 1 year or more with normal conus position on magnetic resonance imaging and abnormal urodynamics were randomized. Exclusion criteria included any neurological conditions, spinal dysraphism, bladder outlet obstruction and an atonic bladder. Patients were assessed at randomization and 1 year later with a standardized urodynamic score, the validated PEMQOL (Pediatric Enuresis Module on Quality of Life™) scale, and a validated bowel and bladder dysfunction score.

RESULTS

After 8 years we accrued 21 patients. The bowel and bladder dysfunction score improved in the surgical and medical arms (20% and 24%) and the urodynamic score improved slightly (6% and 4%, respectively). The PEMQOL Child and Family Impact Scales improved modestly in both groups. All differences were nonsignificant. Interim analysis indicated that more than 700 patients in each arm would be required to demonstrate a statistical difference with respect to urodynamic score based on our preliminary data.

CONCLUSIONS

There appears to be no objective difference in urological outcome between medical management plus or minus filum section for patients with occult tethered cord syndrome. These data challenge the existence of the concept of occult tethered cord syndrome, in which bowel and bladder dysfunction score is attributed to tethering by the filum despite a normally located conus.

Authors+Show Affiliations

Division of Neurosurgery, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia. Electronic address: psteinbok@cw.bc.ca.Department of Urologic Sciences, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia; University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia.Division of Neurosurgery, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia.Department of Urologic Sciences, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia; University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia.HealthActCHQ, Boston, Massachusetts.Division of Neurosurgery, University of Calgary and Alberta Children's Hospital, Calgary.Division of Neurosurgery, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26926544

Citation

Steinbok, Paul, et al. "Filum Section for Urinary Incontinence in Children With Occult Tethered Cord Syndrome: a Randomized, Controlled Pilot Study." The Journal of Urology, vol. 195, no. 4 Pt 2, 2016, pp. 1183-8.
Steinbok P, MacNeily AE, Hengel AR, et al. Filum Section for Urinary Incontinence in Children with Occult Tethered Cord Syndrome: A Randomized, Controlled Pilot Study. J Urol. 2016;195(4 Pt 2):1183-8.
Steinbok, P., MacNeily, A. E., Hengel, A. R., Afshar, K., Landgraf, J. M., Hader, W., & Pugh, J. (2016). Filum Section for Urinary Incontinence in Children with Occult Tethered Cord Syndrome: A Randomized, Controlled Pilot Study. The Journal of Urology, 195(4 Pt 2), 1183-8. https://doi.org/10.1016/j.juro.2015.09.082
Steinbok P, et al. Filum Section for Urinary Incontinence in Children With Occult Tethered Cord Syndrome: a Randomized, Controlled Pilot Study. J Urol. 2016;195(4 Pt 2):1183-8. PubMed PMID: 26926544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Filum Section for Urinary Incontinence in Children with Occult Tethered Cord Syndrome: A Randomized, Controlled Pilot Study. AU - Steinbok,Paul, AU - MacNeily,Andrew E, AU - Hengel,Alexander R, AU - Afshar,Koroush, AU - Landgraf,Jeanne M, AU - Hader,Walter, AU - Pugh,Jeffery, Y1 - 2016/02/28/ PY - 2015/09/09/accepted PY - 2016/3/2/entrez PY - 2016/3/2/pubmed PY - 2016/9/2/medline KW - cauda equina KW - neural tube defects KW - questionnaires KW - urinary bladder KW - urinary incontinence SP - 1183 EP - 8 JF - The Journal of urology JO - J Urol VL - 195 IS - 4 Pt 2 N2 - PURPOSE: Occult tethered cord syndrome, in which there is normal neuroanatomic imaging despite clinical and urodynamic evidence of neuropathic bladder behavior, is controversial. Several uncontrolled series describe improvement in bladder function following section of the filum terminale. We performed a pilot randomized, controlled study comparing medical treatment to surgical section of the filum plus medical treatment in children with occult tethered cord syndrome. MATERIALS AND METHODS: Children refractory to standard medical management for 1 year or more with normal conus position on magnetic resonance imaging and abnormal urodynamics were randomized. Exclusion criteria included any neurological conditions, spinal dysraphism, bladder outlet obstruction and an atonic bladder. Patients were assessed at randomization and 1 year later with a standardized urodynamic score, the validated PEMQOL (Pediatric Enuresis Module on Quality of Life™) scale, and a validated bowel and bladder dysfunction score. RESULTS: After 8 years we accrued 21 patients. The bowel and bladder dysfunction score improved in the surgical and medical arms (20% and 24%) and the urodynamic score improved slightly (6% and 4%, respectively). The PEMQOL Child and Family Impact Scales improved modestly in both groups. All differences were nonsignificant. Interim analysis indicated that more than 700 patients in each arm would be required to demonstrate a statistical difference with respect to urodynamic score based on our preliminary data. CONCLUSIONS: There appears to be no objective difference in urological outcome between medical management plus or minus filum section for patients with occult tethered cord syndrome. These data challenge the existence of the concept of occult tethered cord syndrome, in which bowel and bladder dysfunction score is attributed to tethering by the filum despite a normally located conus. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/26926544/Filum_Section_for_Urinary_Incontinence_in_Children_with_Occult_Tethered_Cord_Syndrome:_A_Randomized_Controlled_Pilot_Study_ L2 - https://www.jurology.com/doi/10.1016/j.juro.2015.09.082?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -