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Chapter 16 - Spina bifida and tethered cord syndrome

from Section 3 - Specific conditions

Published online by Cambridge University Press:  06 December 2010

By
Thomas M. Kessler  and
Gustav Kiss
Edited by
Clare J. Fowler ,
Jalesh N. Panicker  and
Anton Emmanuel
Clare J. Fowler
Affiliation:
The National Hospital for Neurology and Neurosurgery, Queen's Square, London
Jalesh N. Panicker
Affiliation:
The National Hospital for Neurology and Neurosurgery, Queen's Square, London
Anton Emmanuel
Affiliation:
University College London
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Summary

Spina bifida is one of the most common birth defects with a prevalence of 1-1.5 per 1000 births in the UK and Ireland. Neurogenic bladder dysfunction in children with spina bifida can lead to secondary upper urinary tract deterioration and often causes chronic urinary incontinence. With growing number of spina bifida children reaching adolescence and adulthood, sexuality is an increasingly important issue. Bowel dysfunction is a major concern in spina bifida patients. Approximately 10-30% of children with repaired spina bifida will develop neurological deterioration related to tethered cord syndrome. The effect of untethering on lower urinary tract function is uncertain, but it is strongly advocated that there is surgical release of a symptomatic tethered cord irrespective of age. Fecodynamic studies allow early detection of neurogenic disturbances of the anorectum and may be beneficial for determination of the proper time for untethering surgery and also for monitoring in the postoperative follow-up.

Keywords

bladder outlet obstruction managementclean intermittent self-catheterizationelectrical stimulation therapiessuprapubic catheterstress urinary incontinence treatmentsphincter surgeryneurogenic bladder dysfunction
Type
Chapter
Information
Pelvic Organ Dysfunction in Neurological Disease
Clinical Management and Rehabilitation
 , pp. 255 - 265
Publisher: Cambridge University Press
Print publication year: 2010

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