Summary
Introduction
Somatosensory evoked potential (SSEP) and urodynamic studies (UD) are valuable tools
for assessing patients with closed spinal dysraphism (CSD) before neurosurgical intervention.
No studies have correlated their findings in this cohort and our aim is to study their
correlation and prognostic value in pediatric patients with closed spinal dysraphism.
Methods
Retrospective review of all patients referred to a multidisciplinary clinic in a tertiary
pediatric surgical center over a 17 years period between April 2004 to September 2021
was performed. Inclusion criteria were <18 years old, diagnosed with CSD, with SSEP
and UD done within 1 year of each other. Demographics data collected include age at
presentation/at referral/at neurosurgical operation, gender, symptoms at presentation
and intra-operative diagnoses. Pre-operative SSEP and UD findings were documented.
Primary outcome was UD results in the group with normal and abnormal SSEP. Secondary
outcome was urological and bowel function outcome in 4 groups of patients (Group A-both
normal SSEP and UD, Group B- abnormal SSEP only, Group C - abnormal UD only and Group
D-both abnormal SSEP and UD).
Results
A total of 45 patients were included for analysis. Mean follow up time was 118.9 months
(24–216 months, SD 55.8 months). SSEP was normal in 20 patients and abnormal in 25
patients. Baseline demographics, preoperative symptoms and imaging were similar between
2 groups. Primary outcome Patients with abnormal SSEP were more likely to have abnormal UD results with a statistically
significant difference (84% vs 40%, p < 0.05). They have a significantly higher end-fill
detrusor pressure (12% vs 0%, p < 0.05), abnormal bladder compliance (20% vs 0%, p < 0.05),
abnormal cystometric capacity (48% vs 10%, p < 0.05), poor emptying efficiency (24%
vs 5%, p < 0.05) and sphincter incompetence (8% vs 0%, p < 0.05). Secondary outcome When compared to Groups A to C, patients in group D were more likely to be on anti-cholinergic
(33.3% vs 4.3%, p < 0.05), required clean intermittent catheterization (42.9% vs 4.3%,
p < 0.05) and had intravesical botulinum injection (19% vs 0%, p < 0.05). All the
patients who had augmentation cystoplasty were in this group as well. Bowel function
in terms of regular enema use was also statistically significantly higher in this
group (33.4% p < 0.05).
Conclusion
Summary TableUrological and bowel function outcome in group with both normal SSEP and UD versus
group with both abnormal SSEP and UD results.
| Group A Both normal SSEP and UD N = 12 | Group B Abnormal SSEP only N = 4 | Group C Abnormal UD only N = 8 | Group D Both abnormal SSEP AND UD N = 21 | P-value | |
|---|---|---|---|---|---|
| Median age at NS OT (months) | 27 | 14.5 | 23 | 16.5 | 0.051 |
| Median FU time (months) | 102 | 66 | 120 | 120 | 0.087 |
| Anti-cholinergic use | 0 | 0 | 1 (12.5%) | 7 (33.3%) | 0.008∗ |
| Clean intermittent catheterisation use | 1 (8.3%) | 0 | 0 | 9 (42.9%) | 0.006∗ |
| Intravesical botulinum injection | 0 | 0 | 0 | 4 (19%) | 0.039∗ |
| Augmentation cystoplasty | 0 | 0 | 0 | 3 (14.8%) | 0.079 |
| Urinary continence at last FU | 0.433 | ||||
|
11 (91.7%) | 2 (100%) | 5 (71%) | 12 (60%) | |
|
1 (8.3%) | 0 | 1 (14.2%) | 6 (30%) | |
|
0 | 0 | 1 (14.2%) | 2 (10%) | |
| Abnormal renal function on last follow up | 1 (8.3%) | 0 | 0 | 1 (5.6%) | 0.813 |
Keywords
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Article info
Publication history
Published online: December 09, 2022
Accepted:
December 6,
2022
Received in revised form:
December 2,
2022
Received:
August 12,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
