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척수재견인증의 재결박술해소술: 불필요한 방광확대술 |
| 서울대학교 어린이병원 소아비뇨의학과, 소아신경외과¹ |
| 박관진, 임영재, 이지연¹, 김경현¹, 왕규창¹ |
Purpose: Although the most likely cause of urologic deterioration in patients following release as the treatment for tethered cord syndrome (TCS) is secondary TCS (STCS), the redo-untethering has not been attempted as a possible way to address urologic deterioration that has not responded to conventional measures when augmentation cystoplasty (AC) is being considered. This report documents the authors’ team’s long-term experiences to show the effectiveness of redo-untethering as a potential alternative to AC.
Methods: This study evaluated 15 patients with urologic deterioration featuring significant bladder trabeculation, urodynamic storage failure, and no response to conventional treatment who underwent redo-untethering. Clinical and videourodynamic patterns of changes were chronologically described.
Results: Redo-untethering was more difficult than primary untethering, but completed successfully overall, with nonprogressive lower-limb weakness as the orthopedic sequelae in four patients. All patients completed a follow-up of at least 3 years, and six were followed-up for more than 5 years. All patients expressed acceptable control of urinary and fecal incontinence within 3 years of surgery. After 3 years of surgery, all urodynamic storage parameters were nearly normal. Intriguingly, patients with severe trabeculation experienced smoothing of bladder wall in as early as 3 years after surgery, and resolution of significant trabeculation was found in four of six patients after 5 years.
Conclusion: Once release of STCS can be properly performed, this approach may be a better alternative to AC for addressing urologic deterioration. Reversal of bladder trabeculation during long-term follow-up highlights the excellence of this neurologic approach.
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keywords : untethering, augmentation cystoplasty, detrusor sphincter dyssynergia |
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