Urological Evaluation and Psychological-behavioral Profile before and post Detethering Procedures in Children with Tethered Cord Syndrome

Abstract

Abstract Background Tethered cord syndrome (TCS) is a diverse clinical entity characterized by the enhanced tension of the conus medullaris or cauda equina. Surgical detethering is the modality most extensively utilized to treat TCS. It is essential to undertake timely surgery for patients with progressive neuro-urological findings, while the unnecessary surgery should be avoided for those not at risk of deterioration. Disappointingly, some children without bladder impairment present a deterioration of bladder function after surgery, which critically influences the health-related quality of life. To decode the effect of detethering surgery on bladder function and explore the health-related quality of life in children with tethered cord syndrome (TCS). Methods The urodynamic parameters and score were compared before and after detethering. Additionally, the individuals’ psychological-behavioral profile and lower urinary tract symptoms were assessed. Ultimately, the patients were divided into the normal bladder function group (Normal group) and the bladder dysfunction group (Abnormal group) according to the preoperative urodynamics parameters. Results There were statistically significant differences in bladder detrusor sphincter synergy and urodynamic score and no statistically significant difference in the remaining urodynamic parameters and psychological-behavioral items before and after detethering. The proportion of bladder dysfunction that improved or did not worsen after surgery was higher in the Abnormal group than in the Normal group. Nevertheless, the detection rate of each psychological behavior abnormality in children with TCS was higher compared with that of normal children, both preoperatively and postoperatively. Conclusions Surgical detethering could not considerably ameliorate pre-existing bladder dysfunction and patients exhibiting non-progressive bladder function could be treated conservatively with close observation. TCS plagues patients all the time even if detethering. Psychological counseling for children with TCS should be strengthened.