Giddens J L, Radomski S B, Hirshberg E D, Hassouna M, Fehlings M
Division of Urology, Toronto Hospital, University of Toronto, Canada.
J Urol. 1999 Apr;161(4):1249-54.
We evaluated bladder function in adults with the tethered cord syndrome using multichannel urodynamics.
A total of 21 patients a mean 39.6 years old (range 20 to 62) with a tethered cord were evaluated. Of the patients 13 were diagnosed with a tethered cord as an adult and 8 had undergone previous spinal surgery. The tethered cord syndrome was diagnosed by magnetic resonance imaging in 20 patients and computerized tomography myelogram in 1. All patients underwent complete neurological and urological evaluation, including multichannel urodynamics. Needle electromyography and video urodynamics were performed in select cases. Microsurgical release of the tethered cord was performed in 19 patients and 2 refused surgery. Urodynamics were done before surgery in 16 of 19 patients and a median of 12.5 months (range 1 to 40) after surgery in 14. In addition, intraoperative urodynamic monitoring and nerve root stimulation were done in 14 patients to prevent nerve root injury at surgery.
At presentation urgency (67%) and urge incontinence (50%) were the most common findings in 18 patients with urinary symptoms. Pretreatment urodynamics in 18 of 21 patients revealed hyperreflexia in 13 (72%), external detrusor-sphincter dyssynergia in 4 (22%), decreased sensation in 4 (22%), decreased compliance in 3 (17%) and hypocontractile detrusor in 2 (11%). Postoperative urodynamic findings were improved in 4 patients (29%) and unchanged in 10 (71%). Preoperative external detrusor-sphincter dyssynergia in 4 patients resolved postoperatively in 3 and was unchanged in 1. Urinary symptoms were improved in 19% of patients (4), unchanged in 76% (16) and worse in 5% (1). To date 7 patients require anticholinergics, 4 require clean intermittent catheterization and 1 is taking an alpha-blocker.
Adults with the tethered cord syndrome are less likely to have urodynamic or symptom improvement after cord release and most often present with irreversible findings which rarely become worse after surgery. These patients need to have careful and continuous followup, including urodynamic studies, due to possible re-tethering with time.
我们使用多通道尿动力学评估了患有脊髓拴系综合征的成人的膀胱功能。
共评估了21例平均年龄39.6岁（范围20至62岁）的脊髓拴系患者。其中13例患者在成年后被诊断出脊髓拴系，8例曾接受过脊柱手术。20例患者通过磁共振成像诊断出脊髓拴系综合征，1例通过计算机断层扫描脊髓造影诊断。所有患者均接受了全面的神经学和泌尿学评估，包括多通道尿动力学检查。部分病例进行了针极肌电图和影像尿动力学检查。19例患者接受了脊髓拴系的显微手术松解，2例拒绝手术。19例患者中有16例在手术前进行了尿动力学检查，14例在手术后中位数12.5个月（范围1至40个月）进行了尿动力学检查。此外，14例患者在手术中进行了尿动力学监测和神经根刺激，以防止手术中神经根损伤。
在18例有排尿症状的患者中，急迫性（67%）和急迫性尿失禁（50%）是最常见的表现。21例患者中有18例术前尿动力学检查显示，13例（72%）存在反射亢进，4例（22%）存在逼尿肌-外括约肌协同失调，4例（22%）感觉减退，3例（17%）顺应性降低，2例（11%）逼尿肌收缩力减弱。4例患者（29%）术后尿动力学检查结果改善，10例（71%）无变化。术前4例存在逼尿肌-外括约肌协同失调的患者，术后3例症状缓解，1例无变化。19%的患者（4例）排尿症状改善，76%（16例）无变化，5%（1例）症状恶化。迄今为止，7例患者需要使用抗胆碱能药物，4例需要清洁间歇性导尿，1例正在服用α受体阻滞剂。
患有脊髓拴系综合征的成人在脊髓松解术后尿动力学或症状改善的可能性较小，且大多数患者存在不可逆的表现，术后很少恶化。由于随着时间推移可能会再次发生脊髓拴系，这些患者需要进行仔细且持续的随访，包括尿动力学检查。
