title: Does selective dorsal rhizotomy improve bladder function in children with cerebral palsy?
abstract: OBJECTIVE
  To investigate the efficacy of selective dorsal rhizotomy (SDR) on urinary symptoms and bladder function in cerebral palsy children.
  
  
  METHODS
  Selective dorsal rhizotomy was performed in 56 children with spastic cerebral palsy. Intraspinal nerve root divisions over the cauda equina from L1/2 to S1/2 levels were performed. Urinary symptoms and urodynamic study (UDS) parameters before and after SDR were analyzed.
  
  
  RESULTS
  Fifty-four out of 56 children (mean age 7.7) with SDR performed had complete urinary symptoms for analysis, of which 90 % had diplegic cerebral palsy. Fifty-one children had preoperative UDS performed, and 20 children had both preoperative and postoperative UDS. All UDS were performed within 4 weeks before SDR, and the mean time from SDR to post-op UDS was 8.4 months. Before operation, 22 out of 54 (40.7 %) children had urgency or frequency, and 16 out of 54 (29.6 %) children had incontinence. Twelve out of 22 (54.5 %) children with urgency or frequency became completely asymptomatic after SDR (p = 0.013), while 9 out of the 10 children with residual urgency or frequency had significant improvement. Twelve out of 16 (75.0 %) incontinent children became continent after SDR (p = 0.013). Bladder capacity at first incontinence significantly increased from 70 to 130 ml (p = 0.016). Other parameters had no significant difference after SDR. There was a trend that S2 rootlet division had major contribution in achieving continence.
  
  
  CONCLUSIONS
  Selective dorsal rhizotomy significantly improved urgency, frequency, incontinence, and urodynamic bladder capacity at first incontinence in a significant proportion of spastic cerebral palsy children.
authors: Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong SAR, China, peterchiu@surgery.cuhk.edu.hk.
authors: Peter Ka-Fung
authors: PK
authors: Chiu
authors: Kwong-Yui
authors: KY
authors: Yam
authors: Tang-Yu
authors: TY
authors: Lam
authors: Cheung-Hing
authors: CH
authors: Cheng
authors: Cheong
authors: C
authors: Yu
authors: Miu-Ling
authors: ML
authors: Li
authors: Peggy Sau-Kwan
authors: PS
authors: Chu
authors: Chi-Wai
authors: CW
authors: Man
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity; D019051:Rhizotomy / Q000379:methods*; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics