LAUSR

Purpose Controversy exists regarding the role preoperative urodynamic study for asymptomatic closed spinal dysaraphism as it has failed to reveal the benefit in surgical decision and expectation of urological outcomes. We explore the relationship between preoperative videourodynamic study and postoperative urological outcomes after toilet training completed, focusing on their capability of spontaneous voiding. Methods We retrospectively reviewed the data of 181 patients who underwent preventive spinal cord untethering and followed at least till the completion of toilet training. Before untethering, patients underwent preoperative videourodynamic study. Postoperative voiding function was evaluated in three phases 1) till postoperative 6 months 2) till the completion of toilet training 3) two years after toilet training. Changing distribution of emptying pattern at each period was described. Also, relevance to preoperative urodynamic parameters on spontaneous voiding and urinary continence after toilet training was assessed. Results Spinal lipoma and low-lying conus were found in 145 (80%) and 128 (70.7%) patients, respectively. Spontaneous voiding was found in 125 (69.1%), 164 (90.6%) and 162 (89.5%) patients at postoperative 6 months, till the toilet training and two years after toilet training, respectively. Videourodynamics helped to clarify the presence of vesicourethral synergy. This was correlated with spontaneous voiding at postoperative 6 months and better urinary continence after 2 years of toilet training. Conclusions Eventual spontaneous voiding was achieved till toilet training in 90% patients following preventive untethering. Those showing preoperative vesicourethral synergy was associated with faster achievement of spontaneous voiding and better urinary continence when they enter elementary school.