| The long-term surgical outcome in children with tethered cord syndrome have produced controversial and variable results, some lead to uroschesis (or retention of urine), urinary and fecal incontinence, constipation, fecal soiling and so forth, often because of bladder and bowel dysfunction to different degree. We studied and treated a group of patients who have undergone operation because of tethered cord syndrome for this problem, using percutaneous nerve stimulation. The purpose of this study was to assess the functional success of this procedure and its impact on the bowel and bladder function of the patients, by the anorectal manometry, urodynamic study and neuro- electrophysiology of anal sphincter.Material and Methods44 children who had undergone exploration and neurolysis of cauda equine with the diagnosis of meningocele or tethered cord syndrome at the department of pediatric surgery of the Second Affiliated Hospital of China Medical University were followed up successfully by questionnaire survey. The group consisted of 27 males and 17 females, and had a mean age of 11.4 (range, 5-22) years. Twenty children had complicated with bladder and bowel dysfunction and entered in this study.. The group consisted of 12 males and 8 females with the mean age of 11.4 (range, 7-22) years. The mean age at operation was 6.0 years (range, 1 month-10 years). All 20 patients were followed up for 6.6 years (range,1 to 18 years). We treated the children by using percutaneous nerve stimulation for a short-term period in order to improve postoperative bowel and bladder dysfunction. The anorectal manometry, urodynamic study, electromyography (EMG) and neuro-electrophysiology of anal sphincter were performed to evaluate and compare the function of evacuation and urination comprehensively, systematically and dynamically after the management of percutaneous nerve stimulation for a short-term period.Excel 5.0 software for windows was performed for statistical analysis. TheMest and x -test were used to analyze differences in variable parameters before and after nerve stimulation. Probability value p<0.05 was considered statistically significant.ResultsThe scoring of evacuation and urination function increased significantly after nerve stimulation for a short-term period (1.72 0.44 points vs 2.09 0.29 points, P<0.05). There was significant improvement in their symptomatic outcomes. The preoperative parameters of evacuation and urination functions had completely or incompletely resolved. Pressure of anal canal contraction and vector volume of anal canal contraction were 113.99 59.98 mmHg vs 169.27 41.25mmHg and 46174.95 929.37 cm*mmHg2 vs 69021.25 785.65 cm*mmHg2, respectively, which were significantly different after the treatment of nerve stimulation(P<0.05). Patients with bladder content less than 50%, low compatibility of detrusor urinae, residue urine more than 50ml and unstable bladder decreased obviously after nerve stimulation therapy. The latent period of perineum- anus reflex and spinal cord-anus reflex was 84.98 + 13.82ms vs 52.02 10.81ms and 6.73 1.32ms vs 4.62 0.99ms after nerve stimulation therapy , respectively, and it was proved to be more decreasing than that before therapy(P<0.05). Patients had significantly reduced sensor threshold of perineal skin (31.15 3.51 vs 17.03 1.37, P<0.05) and sensor threshold ofperianal skin (49.56 17.32 vs 21.15 5.47, P<).05) after the treatment of nerve stimulation.Conclusions1. Neuro-electrophysiology of anal sphincter, urodynamic study, and anorectal manometry could be used to identify the pathogenesis of evacuation and urination in postoperative children with tethered cord syndrome and evaluate the result after treatment.2. This study proved that percutaneous nerve stimulation for a short-term period is an effective therapy for improvment of bowel and bladder function, and it is helpful to improve quality of life of patients. |
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