ESPU Congress 2017 - Abstract book

276

CONGRESS OF THE ESPU

S25-11 (P without presentation)

META-ANALYSIS AND SYSTEMATIC REVIEW OF UROLOGIC

OUTCOMES FROM TETHERED CORD RELEASE IN OCCULT

SPINAL DYSRAPHISM IN CHILDREN

Jaun Carlos PRIETO

, Jeffrey WHITE

and Maria RODRIGUEZ

1) University of Texas Health Sciences Center, Urology, San Antonio, USA - 2) University of Texas Health Science

Center, Urology, Houston, USA

PURPOSE

Review the urologic outcomes after untethering of occult spinal dysraphism, the closed skin variant

of TCS.

MATERIAL AND METHODS

A systematic literature review was performed via Pubmed and Ovid, following PRISMA guidelines.

Of the original 536 publications in the past 25 years, 17 manuscripts met inclusion criteria. The

following biases were assessed: study participation, study attrition, prognostic factor and outcome

measurement, confounding measurement and account, and analysis. Studies with high risk for

bias were excluded. For each study, the pre- and postoperative data (urological symptoms and

urodynamics data) were extracted to evaluate outcomes after untethering. We calculated the sum-

mary estimate of effect of untethering using random-effects and fixed-effects models.

RESULTS

The most common urological symptoms in TCS were urinary incontinence, frequency-urgency

and febrile and non-febrile urinary tract infections. Urodynamics (UDS) findings included detru-

sor overactivity, detrusor-sphincter dyssynergia, hypotonia/areflexia and decreased compliance.

Meta-analysis and systematic review demonstrated varying degrees of success from untethering:

improvement in UDS ranged from 5 % to 93% and improvement in urological symptoms ranged

from 17% to 70%. These wide ranges are due to inconsistent classification and definition of terms,

patient selection bias, and the varied timing of surgical intervention. Untethering produced a statisti-

cally significant reduction in the pooled odds ratio for urinary incontinence by 89.1% (61.8%-96.7%)

and detrusor overactivity by 63.4% (20%-83.2%).

CONCLUSIONS

These results prompted several conclusions. First, the different subgroups and different nomencla-

ture of tethered cord syndrome are often confused, making interpretation of results difficult. Second,

untethering has a positive effect on urologic symptoms and urodynamics parameters. Third, timing

of untethering is important: early intervention prevents significant long-term traction aiming to avoid

irreversible neurologic damage. Fourth, a multidisciplinary team is required for diagnosis and treat-

ment of occult spinal dysraphism.