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 ORIGINAL ARTICLE
Year : 2009  |  Volume : 4  |  Issue : 2  |  Page : 70-72

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


Department of Urology, Urology and Nephrology Center, Mansoura, Egypt

Correspondence Address:
Ahmed S El - Hefnawy
Urology and Nephrology Center, Mansoura
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.57324

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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.






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