title: Utility of urodynamics in the management of asymptomatic tethered cord in children.
abstract: BACKGROUND
  We have noted a recent increase in neurosurgical requests at our institution for urodynamics (UDS) prior to release of asymptomatic tethered cord. Our aim was to determine how preoperative UDS results are used in the clinical management of asymptomatic tethered cord.
  
  
  METHODS
  A retrospective review was performed of 120 patients diagnosed with primary tethered cord from 2007 to 2010. Inclusion criteria included MRI diagnosis of tethered cord and UDS performed by three pediatric urologists. Excluded were any neurologic or urologic dysfunction or associated syndromes, as well as other significant comorbidities.
  
  
  RESULTS
  Thirty-eight patients (female 26; male 12), mean age of 3 years (0.2-16.3) were diagnosed with an asymptomatic tethered cord. The majority of the patients had normal preoperative renal ultrasounds. Thirty-one (82 %) of the children had normal baseline UDS, yet twenty-one (68 %) of these patients still underwent neurosurgical intervention. Of the 27 patients untethered, 15 patients (55 %) had follow-up UDS performed. Three patients had improved UDS parameters and one had worsening UDS parameters, including high PVR and DSD. Of the seven patients with abnormal baseline UDS, all had normal renal ultrasound findings and had no other significant differences in presentation from the patients with normal UDS.
  
  
  CONCLUSIONS
  In children with asymptomatic tethered cord, abnormal preoperative UDS may prompt intervention, while normal UDS do not appear to prevent intervention. There is no significant correlation between abnormal preoperative UDS and abnormal preoperative imaging. Further study is needed to evaluate the utility of this procedure in the preoperative setting in this asymptomatic patient population.
authors.affiliation: Division of Pediatric Urology, Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA, broderick.kristin@gmail.com.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Broderick
authors.forename: Oxana
authors.initials: O
authors.lastname: Munoz
authors.forename: C D Anthony
authors.initials: CD
authors.lastname: Herndon
authors.forename: David B
authors.initials: DB
authors.lastname: Joseph
authors.forename: David M
authors.initials: DM
authors.lastname: Kitchens
mesh_terms: D000293:Adolescent; D058070:Asymptomatic Diseases; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004576:Electromyography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009436:Neural Tube Defects / Q000503:physiopathology* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D014563:Urodynamics