Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Clin Neurophysiol. 2018 Dec;129(12):2594-2601. doi: 10.1016/j.clinph.2018.09.026. Epub 2018 Oct 30.
To evaluate the clinical significance of intraoperative bulbocavernosus reflex (BCR) during untethering surgery in predicting post-operative voiding function.
We conducted a retrospective review of pediatric patients who underwent untethering surgery with available intraoperative baseline BCR. BCR response during surgery was classified into loss or maintenance. Post-operative voiding function was determined as worsened or maintained based on history, postvoid residual urine measurement, and urodynamic study (UDS). Data regarding demographics, diagnosis, pre-operative voiding difficulty, re-untethering, syrinx, and abnormalities in electromyography were collected for analysis.
We included 106 patients, with a mean age of 3.3 years, and 49 patients were male. BCR was lost in 15 patients during surgery and voiding function worsened in 14 patients after surgery. Lumbosacral lipoma was the most common diagnosis, and 16 patients were diagnosed with lipomyelomeningocele (LMMC). The sensitivity and specificity of intraoperative BCR for post-operative worsening of voiding function were 35.7%, and 88.5% at 6 months, respectively. The diagnosis of LMMC was statistically significant in a logistic regression analysis. The specificity of BCR at 6 months in patients with diagnosis other than LMMC was 93.4%, and intraoperative BCR was significant in a logistic regression analysis.
Intraoperative BCR during untethering could predict bladder function 6 months post-operatively with high specificity (88.5%), particularly in cases other than LMMC (93.4%), indicating that voiding function deterioration will not occur if intraoperative BCR is preserved.
Intraoperative BCR during untethering surgery is a useful tool to predict post-operative voiding outcome.
评估术中球海绵体反射（BCR）在松解术中的临床意义，以预测术后排尿功能。
我们回顾性分析了 106 例接受松解术且术中存在基线 BCR 的小儿患者。术中 BCR 反应分为丧失或保留。术后排尿功能根据病史、残余尿测量和尿动力学研究（UDS）确定为恶化或保留。收集人口统计学、诊断、术前排尿困难、再次松解、脊髓空洞和肌电图异常等数据进行分析。
我们纳入了 106 例患者，平均年龄为 3.3 岁，其中 49 例为男性。15 例患者术中 BCR 丧失，14 例患者术后排尿功能恶化。腰骶部脂肪瘤是最常见的诊断，16 例患者诊断为脂肪脊膜脊髓膨出（LMMC）。术中 BCR 对术后排尿功能恶化的敏感性和特异性分别为 35.7%和 88.5%，在 6 个月时。LMMC 的诊断在逻辑回归分析中具有统计学意义。非 LMMC 患者的 6 个月 BCR 特异性为 93.4%，术中 BCR 在逻辑回归分析中具有统计学意义。
松解术中的术中 BCR 可以预测术后 6 个月的膀胱功能，特异性高（88.5%），尤其是在非 LMMC 患者中（93.4%），表明如果术中 BCR 保留，排尿功能恶化不会发生。
松解术中的术中 BCR 是预测术后排尿结局的有用工具。
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