title: Effect of detethering on bladder function in children with myelomeningocele: Urodynamic evaluation.
abstract: OBJECTIVE
  To study the effect of detethering of the cord on urodynamic changes in patients with myelomeningocele.
  
  
  METHODS
  We retrospectively reviewed the urodynamic data of 37 patients. In all of them myelomeningocele primary repair was carried out. The patients were divided into two groups: (1) those who underwent detethering of the cord and (2) those who did not. Neurourological examination, filling cystometry, assessment of bladder management, and fecal continence were studied in all patients.
  
  
  RESULTS
  Eleven (29.7%) out of 37 patients underwent detethering of the cord. The mean age at presentation was 10.1 ± 4 and 10.8 ± 7 years in groups 1 and 2, respectively (P 0.7). Nocturnal and diurnal enuresis was found in 45% of group 1, while it was found in 69% of group 2. Fecal soiling was detected in 18% in group 1 and in 38.5% in group 2. Mean bladder capacity was 210 ± 125 cc and 199 ± 120 cc for groups 1 and 2, respectively (P 0.8). Uninhibited detrusor contractions were noticed in nine patients (82%) of group 1 and in 21 patients (81%) of group 2. Delta det LPP was lower in group 1 (35 ± 19 cm H(2)O) than in group 2 (46 ± 40 cm H(2)0).
  
  
  CONCLUSIONS
  Detethering of the cord had a positive impact on patients with myelomeningocele in terms of lowering of det LPP and accordingly decreasing the risk of upper tract deterioration.
authors: Department of Urology, Urology and Nephrology Center, Mansoura, Egypt.
authors: Ahmed S
authors: AS
authors: El-Hefnawy
authors: Bassem S
authors: BS
authors: Wadie