Palmer L S, Richards I, Kaplan W E
Division of Urology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois, USA.
J Urol. 1998 Jan;159(1):231-4. doi: 10.1016/s0022-5347(01)64074-6.
We evaluated the urodynamic findings in myelodysplastic children with the tethered cord syndrome without urological symptoms to determine if occult bladder changes occur or if routine preoperative urodynamic evaluation is not indicated for this select population.
Preoperative and postoperative urodynamic studies were performed on children with myelodysplasia and the tethered cord syndrome between 1988 and 1994. Inclusion criteria were neurological or musculoskeletal surgical indications only, without urological status changes, radiographic confirmation of the tethered cord syndrome, and water cystometry performed preoperatively within 1 week and again postoperatively within 6 months. The parameters of interest included total bladder capacity and pressure, leak point pressure, compliance, uninhibited contractions, electromyelogram activity and sensation.
A total of 20 children, 11 girls and 9 boys, 2.3 to 17.3 years old were included in the study. Worsening scoliosis and lower extremity weakness were the most common presentations. Urodynamic studies were conducted 1.8 days preoperatively (mean) and 104.3 days postoperatively (mean). Results were analyzed with regard to improvement or deterioration between preoperative and postoperative urodynamic studies. Of the 20 children 15 (75%) demonstrated improvement between the 2 urodynamic studies, including 10 who improved in 1 parameter (most often with resolution of uninhibited contractions), 3 in 2, 1 in 3 and 1 in 4. There were no significant postoperative changes for any of the specific parameters. Urodynamic studies identified 7 children with preoperative leak point pressures above 40 cm. water, of whom only 2 had decreased pressures below 40 cm. water, 2 had postoperative deterioration of compliance and 1 had preoperative detrusor-sphincter dyssynergia.
Routine preoperative and postoperative urodynamic evaluations in children with the tethered cord syndrome without clinical changes to urological status may be important. The majority of clinically asymptomatic children will demonstrate preoperative urodynamic findings that improve postoperatively, which serves as another marker of progress after spinal cord untethering. Moreover, some asymptomatic children will demonstrate changes to the urinary tract that merit management changes, such as detrusor-sphincter dyssynergia, elevated bladder storage pressures and poor compliance, which may have otherwise been delayed in recognition.
我们评估了患有脊髓拴系综合征但无泌尿系统症状的脊髓发育不良儿童的尿动力学检查结果，以确定是否存在隐匿性膀胱改变，或对于这一特定人群是否无需进行常规术前尿动力学评估。
对1988年至1994年间患有脊髓发育不良和脊髓拴系综合征的儿童进行术前和术后尿动力学研究。纳入标准仅为神经或肌肉骨骼手术指征，无泌尿系统状况改变，脊髓拴系综合征的影像学确认，以及术前1周内和术后6个月内进行水囊测压。感兴趣的参数包括膀胱总容量和压力、漏点压力、顺应性、无抑制性收缩、肌电图活动和感觉。
共有20名儿童纳入研究，其中11名女孩和9名男孩，年龄在2.3至17.3岁之间。脊柱侧弯加重和下肢无力是最常见的表现。尿动力学研究在术前平均1.8天和术后平均104.3天进行。分析术前和术后尿动力学研究之间的改善或恶化情况。在20名儿童中，15名（75%）在两次尿动力学研究之间表现出改善，其中10名在1个参数上有所改善（最常见的是无抑制性收缩消失），3名在2个参数上改善，1名在3个参数上改善，1名在4个参数上改善。任何特定参数术后均无显著变化。尿动力学研究发现7名儿童术前漏点压力高于40 cm水柱，其中只有2名压力降至40 cm水柱以下，2名术后顺应性恶化，1名术前存在逼尿肌-括约肌协同失调。
对于脊髓拴系综合征且泌尿系统状况无临床改变的儿童，常规术前和术后尿动力学评估可能很重要。大多数临床无症状的儿童术前尿动力学检查结果术后会有所改善，这是脊髓松解术后病情进展的另一个标志。此外，一些无症状儿童会出现泌尿系统改变，值得调整治疗方案，如逼尿肌-括约肌协同失调、膀胱储尿压力升高和顺应性差，否则这些情况可能会延迟发现。
