TETHERED CORD SYNDROME IN CHILDREN WITH DAYTIME INCONTINENCE

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  • Morizawa Yosuke
    Department of Urology, Tokyo Metropolitan Children's Medical Center
  • Satoh Hiroyuki
    Department of Urology, Tokyo Metropolitan Children's Medical Center
  • Sato Atsuko
    Department of Urology, Tokyo Metropolitan Children's Medical Center
  • Iwasa Shun
    Department of Urology, Tokyo Metropolitan Children's Medical Center Department of Urology, Keio University School of Medicine
  • Aoki Yujiro
    Department of Urology, Tokyo Metropolitan Children's Medical Center Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University

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  • 昼間尿失禁精査を契機に診断された脊髄係留症候群の検討

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Abstract

<p> (Introduction) In tethered cord syndrome, the lower end of the spinal cord is moored to the caudal tissue, causing various neuropathies. Bladder dysfunction often appears early. We herein evaluated children with daytime urinary incontinence in whom tethered cord syndrome was eventually diagnosed.</p><p> (Method) Eighteen children (9 males and 9 females) with daytime urinary incontinence were enrolled between March 2011 and October 2017. The causes of their urinary incontinence were investigated using spinal MRI and changes in clinical symptoms before and after untethering surgery.</p><p> (Results) The average age at the first visit was 6.3 years (range: 4-9 years). Urodynamic testing and a voiding cystourethrogram (VCUG) were performed in all cases of refractory daytime incontinence, and all patients with abnormal findings on either test underwent spinal MRI. The diagnosis based on spinal MRI findings was filum lipoma in eight, occult tethered cord syndrome in four, low set conus in four, conus lipoma in one, and sacral meningeal cyst in one, patient. The average observation period after untethering surgery was 66.3 months (range: 22-116 months). All the patients achieved a cure postoperatively. Four patients were treated for nocturnal enuresis by oral medication, and three patients required urological management via clean, intermittent catheterization.</p><p> (Conclusions) When treating children with daytime continence, one should consider the possibility of tethered cord syndrome, the diagnosis of which can be aided by urodynamic assessment of bladder function.</p>

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