Zhou Zhaokai,Yang Shuai,Yu Jiating,et al.Urodynamic changes and clinical significance before and after detethering surgery[J].Journal of Clinical Pediatric Surgery,,22():731-736.[doi:10.3760/cma.j.cn101785-202211042-006]
Urodynamic changes and clinical significance before and after detethering surgery
- Keywords:
- Eethered Cord Syndrome; Neurosurgical Procedures; Urodynamic Study; Minimal Clinically Important Difference; Child
- Abstract:
- Objective To explore the effect of detethering surgery on bladder function by comparing the results of urodynamic studies (UDS) before and after detethering surgery in children with tethered cord syndrome (TCS).Methods A total of 43 children diagnosed with TCS at First Affiliated Hospital of Zhengzhou University from January 2019 to October 2021 were recruited.The UDS parameters before and after detethering surgery were collected.Some UDS parameters were quantified and scored for examining the changes before and after surgery.According to preoperative UDS parameters and lower urinary tract symptoms, they were assigned into two groups of normal bladder function (normal group, n=24) and abnormal bladder function (abnormal group, n=19).The changes in UDS parameters and lower urinary tract symptoms were compared between two groups to assess the postoperative function of urinary system.Results The operative age was (4.0±4.5) years.Pre/post-operative urodynamic results showed statistically significant differences in bladder detrusor sphincter synergy[1.00(0.00, 1.00) vs.1.00 (0.00, 2.00)]and UDS scores[4.00(2.00, 7.00) vs.6.00(1.00, 9.00)]were statistically significant before and after the procedure (P<0.05); maximal flow rate[12.00(9.00, 13.00) vs.12.00(5.00, 15.00) mL/s], post void residual[20.00(7.00, 50.00) vs.20.00(5.00, 40.00) mL], maximal bladder capacity[0.00(0.00, 1.00) vs.0.00(0.00, 1.00)], bladder compliance[1.00(0.00, 2.00) vs.1.00(0.00, 2.00)]and bladder compliance[2.00(1.00, 3.00) vs.3.00(0.00, 4.00)].The differences were not statistically significant (P>0.05).Ratio of gender composition between two groups[(n=10, 41.7%) vs.(n=9, 47.4%), χ2=0.140], proportion of improvement in motor/sensory dysfunction of lower limbs[(n=17, 70.8%) vs.(n=14, 73.7%), χ2=0.029]and proportion of improvement in lower limb motor/sensory dysfunction[(n=19, 79.2%) vs.(n=11, 57.9%), χ2=2.275].The differences were not statistically significant (P>0.05); proportion of improvement in postoperative bladder dysfunction was higher in abnormal group than in normal group[(n=14, 73.7%) vs.(n=8, 33.3%), χ2=6.910]with a statistically significant difference (P<0.05).Conclusion Detethering surgery may improve bladder dysfunction in some children with preoperative bladder dysfunction.In children without preoperative bladder dysfunction, detethering surgery may cause bladder function impairment.Therefore detethering surgery should be performed with a great caution.
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Memo
收稿日期:2022-11-21。
基金项目:国家自然科学基金（U1904208）
通讯作者:文建国,Email:wenjg@hotmail.com