Urodynamic Evaluation of Neurosurgical Effect in Myelodysplasia

Kim, Kwang Myung; Jung, Jung Yun; Kim, Dae Kyung

Abstract

PURPOSE: To evaluate neurosurgical effect in the pediatric patients with myelodysplasia we reviewed preoperative and postoperative videourodynamic results.
MATERIALS AND METHODS
All the 24 patients received untethering of spinal cord. Twenty postoperative urodynamic studies were performed between 6 months and 1 year, and 4 were performed at 3 months after operation. Uninhibited contraction and detrusor-sphincter dyssynergia(DSD) were checked in the patients having detrusor contraction and leak pressure was measured in areflexic bladder.
RESULTS
Preoperative normal urodynamic finding was found in 6 patients. Among them one patient showed hyperreflexia with synergic voiding after operation. Normal detrusor contraction with DSD was found in 2 patients preoperatively One of these patients changed to high pressure areflexia Nine patients showed hyperreflexia preoperatively. Four patients among them had DSD. Five hyperreflexic bladders without DSD showed normoreflexia without 858 in one, low pressure areflexia in 3 and no change in one after operation. Out of four patients with hyperreflexia having DSD 2 showed high pressure areflexia, 1 showed atomic bladder and no change was seen in one. Seven patients had areflexia preoperatively. One patient with low pressure areflexia preoperatively showed high pressure areflexia postoperatively and 6 patients with high pressure areflexia preoperatively showed hyperreflexia with DSD in two and atonic bladder in one and no changes in 3 patients.
CONCLUSIONS
From the above data we think that main urodynamic effect by neurosurgical treatment is decreasing detrusor activity. Although this effect on detrusor contraction is likely to be beneficial to myelodysplastic patients, more durable sphincteric activity may offset this profit.