Effect of detethering on bladder function in children with myelomeningocele: Urodynamic evaluation

AIM OF WORK: To study the effect of detethering of the cord on urodynamic changes in patients with myelomeningocele. MATERIALS AND METHODS: We retrospectively reviewed the urodynamic data of 37 patients. In all of them myelomeningocele primary repair was carried out. The patients were divided into two groups: (1) those who underwent detethering of the cord and (2) those who did not. Neurourological examination, filling cystometry, assessment of bladder management, and fecal continence were studied in all patients. RESULTS: Eleven (29.7%) out of 37 patients underwent detethering of the cord. The mean age at presentation was 10.1 ± 4 and 10.8 ± 7 years in groups 1 and 2, respectively (P 0.7). Nocturnal and diurnal enuresis was found in 45% of group 1, while it was found in 69% of group 2. Fecal soiling was detected in 18% in group 1 and in 38.5% in group 2. Mean bladder capacity was 210 ± 125 cc and 199 ± 120 cc for groups 1 and 2, respectively (P 0.8). Uninhibited detrusor contractions were noticed in nine patients (82%) of group 1 and in 21 patients (81%) of group 2. Delta det LPP was lower in group 1 (35 ± 19 cm H(2)O) than in group 2 (46 ± 40 cm H(2)0). CONCLUSION: Detethering of the cord had a positive impact on patients with myelomeningocele in terms of lowering of det LPP and accordingly decreasing the risk of upper tract deterioration.