Our Summary

This study looks at the effect of a specific surgery called detethering surgery (DS) on bladder function and quality of life in children with a condition called Tethered cord syndrome (TCS). TCS is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord. The surgery is typically used to treat this condition, but sometimes it can lead to a worsening of bladder function in children who didn’t have any initial bladder problems.

The researchers studied 83 patients aged between 6 and 10 years old who had TCS and underwent DS. They compared the patients’ bladder function and psychological wellbeing before and after the surgery. They also divided the patients into two groups - “normal” and “abnormal”, based on their bladder function before the surgery.

The results showed that while there were some significant improvements in bladder function and urodynamic score (a measure of how well the bladder and urethra are storing and releasing urine), the surgery did not significantly improve pre-existing bladder problems. In fact, the rate of bladder dysfunction that got better or didn’t get worse after the surgery was higher in the group with abnormal pre-surgery bladder function.

Interestingly, the researchers also found that children with TCS had more psychological behavior abnormalities than normal children, both before and after the surgery. This suggests that psychological counseling for these children should be increased after DS.

In conclusion, while DS can help some aspects of bladder function in children with TCS, it doesn’t significantly improve pre-existing bladder problems, and it may be better to treat non-progressive bladder dysfunction with close observation rather than surgery. It’s also important to pay more attention to the psychological wellbeing of these children.

FAQs

  1. What is detethering surgery (DS) and what condition does it treat?
  2. What were the effects of DS on bladder function and psychological wellbeing in children with Tethered cord syndrome (TCS)?
  3. Should detethering surgery be used to treat non-progressive bladder dysfunction in children with TCS?

Doctor’s Tip

A helpful tip a doctor might tell a patient about detethering surgery is to carefully monitor bladder function before and after the surgery. While the surgery may improve some aspects of bladder function, it may not significantly help pre-existing bladder problems. It’s important to communicate any changes or concerns with your healthcare provider to ensure the best possible outcome. Additionally, psychological counseling may be beneficial for children with TCS both before and after the surgery to address any behavioral abnormalities.

Suitable For

Patients who are typically recommended detethering surgery are those with Tethered cord syndrome (TCS) who are experiencing symptoms such as lower back pain, leg weakness, bowel or bladder dysfunction, and changes in gait. These symptoms are often caused by the spinal cord being abnormally attached to surrounding tissues, leading to tension and limited movement.

Detethering surgery is recommended for patients with TCS who are experiencing progressive symptoms or worsening neurological function. It is also recommended for patients who have abnormal bladder function that is impacting their quality of life. However, as the study mentioned, the surgery may not significantly improve pre-existing bladder problems, so careful consideration should be given to the potential risks and benefits of the surgery in these cases.

Timeline

Overall, the timeline of a patient’s experience before and after detethering surgery can be described as follows:

Before surgery:

  1. Patient is diagnosed with Tethered Cord Syndrome (TCS) due to neurological symptoms caused by tissue attachments limiting the movement of the spinal cord.
  2. Patient may experience bladder dysfunction and other symptoms related to TCS.
  3. Patient undergoes pre-operative evaluations to assess bladder function and overall health.
  4. Surgical team plans for detethering surgery to release the spinal cord.
  5. Patient and family receive counseling and support to prepare for the surgery.

After surgery:

  1. Patient undergoes detethering surgery to release the spinal cord and improve symptoms related to TCS.
  2. Patient is monitored closely in the post-operative period for any complications or changes in symptoms.
  3. Patient may experience improvements in bladder function and other neurological symptoms as a result of the surgery.
  4. Patient may require physical therapy, occupational therapy, or other rehabilitation services to aid in recovery.
  5. Patient follows up with the surgical team for post-operative appointments and evaluations.
  6. Patient may require additional support for psychological wellbeing, especially if there are pre-existing psychological behavior abnormalities.
  7. Patient continues to be monitored for long-term outcomes and may require ongoing care for any residual symptoms or complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about detethering surgery include:

  1. What is the success rate of detethering surgery for TCS in children?
  2. What are the potential risks and complications associated with detethering surgery?
  3. How will detethering surgery specifically affect my child’s bladder function?
  4. Are there alternative treatment options for TCS besides surgery?
  5. How long is the recovery process after detethering surgery?
  6. Will my child need ongoing follow-up care or physical therapy after the surgery?
  7. How will detethering surgery impact my child’s quality of life in the long term?
  8. Are there any psychological or behavioral considerations to take into account before and after the surgery?
  9. What are the specific criteria for determining if detethering surgery is the best treatment option for my child?
  10. Can you provide references to other patients who have undergone detethering surgery for TCS, so I can learn about their experiences?

Reference

Authors: Yang S, Zhou Z, Liu X, Wang Z, Zhang Y, Zhang H, Lv L, Wen Y, Wang Q, Jia W, Hu J, Wen JG. Journal: Int Braz J Urol. 2025 Jan-Feb;51(1):e20240311. doi: 10.1590/S1677-5538.IBJU.2024.0311. PMID: 39556851