We evaluated prospectively 26 patients with myelodysplasia and a tethered spinal cord to determine whether surgical release of the tethered cord positively influenced leak point pressure, bladder compliance, upper tract status and/or clinical management. Urodynamics were performed immediately before and after the neurosurgical procedure, and at 3 and 6 months postoperatively. Mean patient age was 7.8 years (range 2 days to 34 years) and median interval from onset of symptoms to surgery was 60 days (range 2 days to 4 years). Patient presentation included a combination of orthopedic, neurological and urological symptoms. Of 26 patients 9 (35%) had new hydronephrosis, urinary tract infections or urinary incontinence. Leak point pressure and bladder compliance did not change significantly by 6 months postoperatively. Of the 4 patients who presented with hydronephrosis 1 worsened in status, 2 stabilized and 1 improved. Clinical status was unchanged in 16 patients, improved in 4 and worsened in 6. There was no significant relationship between patient age and urodynamic or clinical outcome. Among patients followed for at least 6 months radiographic and clinical improvement occurred in 25% and 15%, respectively. Urodynamic improvements were transient. Surgical release of a tethered cord improved the urological status in less than a quarter of the patients in this series.

The Journal of urology

neural tube defects; urodynamics; spinal cord; myelodysplastic syndromes; Biological and medical sciences; Investigative techniques, diagnostic techniques (general aspects); Investigative techniques of renal and urinary tract function; Medical sciences; Spinal Cord - abnormalities; Neural Tube Defects - physiopathology; Prospective Studies; Compliance; Follow-Up Studies; Humans; Child, Preschool; Infant; Male; Neural Tube Defects - surgery; Neural Tube Defects - complications; Pressure; Spinal Cord - surgery; Urodynamics; Adolescent; Urinary Bladder - physiopathology; Adult; Female; Hydronephrosis - surgery; Spinal Cord - physiopathology; Hydronephrosis - etiology; Child; Infant, Newborn; Index Medicus; Abridged Index Medicus; neural tube defects; urodynamics; spinal cord; myelodysplastic syndromes; Human; Bladder function; Dysraphia; Nervous system diseases; Urinary system disease; Prognosis; Urinary tract disease; Urodynamics; Treatment; Neural tube; Malformation; Surgery; Central nervous system disease; Neurogenic bladder; Bladder disease; Neurological disorder; Spinal cord disease; Child

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