Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan 450052, China.
Henan Joint International Paediatric Urodynamic Laboratory, Henan 450052, China.
Int Braz J Urol. 2025 Jan-Feb;51(1). doi: 10.1590/S1677-5538.IBJU.2024.0311.
Currently, detethering surgery (DS) is the modality most extensively utilized to treat primary Tethered cord syndrome (TCS). Disappointingly, some children without bladder impairment showed a deterioration of bladder function after surgery, which critically influences the health-related quality of life. It was hypothesized that the DS might have a significant effect on bladder function and psychology. Therefore, the purpose of this study was to investigate the effect of DS on bladder function and quality of life in children with primary TCS.
A retrospective study of 83 patients aged 6 to 10 years who were diagnosed with TCS and underwent DS between 2022 and 2023. The urodynamic parameters and score, psychological-behavioral profile, and lower urinary tract symptoms were compared before and after DS. Additionally, the patients were divided into the normal group and the abnormal group according to the preoperative urodynamics parameters.
A total of 66 children fulfilled the criteria, with a mean age at surgery of 89.5 ± 13.7 months. There were statistically significant differences in bladder detrusor sphincter synergy and urodynamic score and no statistically significant difference in the remaining urodynamic parameters and psychological-behavioral items before and after DS. The proportion of bladder dysfunction that improved or did not worsen after surgery was higher in the Abnormal group than in the Normal group. Nevertheless, the detection rate of each psychological behavior abnormality in children with TCS was higher compared with that of normal children, both preoperatively and postoperatively.
DS could not considerably ameliorate pre-existing bladder dysfunction and patients exhibiting non-progressive bladder dysfunction could be treated conservatively with close observation. TCS plagues patients all the time even if detethering. Psychological counseling for children with TCS should be strengthened after DS.
目前，松解术（DS）是治疗原发性脊髓栓系综合征（TCS）最广泛应用的方法。令人失望的是，一些没有膀胱功能障碍的儿童在手术后出现膀胱功能恶化，这对健康相关的生活质量有重大影响。有人假设 DS 可能对膀胱功能和心理有显著影响。因此，本研究旨在探讨 DS 对原发性 TCS 患儿膀胱功能和生活质量的影响。
回顾性分析 2022 年至 2023 年期间 83 例 6-10 岁 TCS 患儿行 DS 的病例。比较 DS 前后的尿动力学参数和评分、心理行为特征和下尿路症状。此外，根据术前尿动力学参数将患者分为正常组和异常组。
共有 66 名儿童符合标准，手术时平均年龄为 89.5±13.7 个月。DS 前后膀胱逼尿肌括约肌协同作用和尿动力学评分有统计学差异，其余尿动力学参数和心理行为项目无统计学差异。异常组术后膀胱功能改善或无恶化的比例高于正常组。然而，TCS 患儿的每一种心理行为异常的检出率在术前和术后均高于正常儿童。
DS 不能显著改善术前存在的膀胱功能障碍，对于表现为非进行性膀胱功能障碍的患者，可保守治疗密切观察。即使松解后 TCS 仍会困扰患者。DS 后应加强对 TCS 患儿的心理咨询。
