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Correlation of urodynamic studies and somatosensory evoked potential and their prognostic value in children with closed spinal dysraphism

Published:December 09, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.12.004

      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
      • Continent without CIC
      11 (91.7%) 2 (100%) 5 (71%) 12 (60%)
      • Continent on CIC
      1 (8.3%) 0 1 (14.2%) 6 (30%)
      • Incontinent
      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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