Study of Tethered Spinal Cord Syndrome Diagnosis Following a Close Examination of Daytime Urinary Incontinence
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Diurnal urinary incontinence
Spinal cord compression



Submitted : 2023-05-15
Accepted : 2023-05-30
Published : 2023-06-14


Background: Tethered spinal cord syndrome refers to neurological disorders caused by the lower end of the spinal cord becoming entrapped in the caudal tissue. Dysuria is one of the most common symptoms and often appears at an early stage. In this study, we investigated cases of children with tethered spinal cord syndrome who were presented to the urology department with daytime urinary incontinence. Subjects and methods: Eighteen children with tethered spinal cord syndrome were diagnosed between March 2011 and October 2017 after a visit to the urology department with daytime urinary incontinence as the main complaint. The reasons for the diagnosis of tethered spinal cord syndrome and the changes in clinical symptoms before and after laminectomy were investigated. Results: Nine boys and nine girls were selected as the study subject. The mean age at the first examination was 6.3 years (range 4–9 years). All patients underwent urodynamics and voiding cystourethrogram (VCUG) for refractory daytime urinary incontinence. Spinal MRI was performed in all patients to investigate abnormal findings on VCUG and urodynamics. Only four patients had indications of tethered spinal cord syndrome on MRI. Eight patients had lipoma of the filum terminale, four patients had potential tethered spinal cord syndrome, four patients had low-lying conus, one patient with conus lipoma, and one patient had intrasacral meningeal cyst. The mean follow-up after laminectomy was 66.3 (22–116) months, 11 patients were asymptomatic, 4 patients had residual nocturia only, and 3 patients were managed with intermittent voiding. Conclusion: It is necessary to treat patients with daytime urinary incontinence is one of the symptoms of the tethered spinal cord syndrome. Bladder function assessed by urodynamics may provide a diagnostic sign for spinal cord compression.


Alsowayan O, Alzahrani A, Farmer JP, et al., 2016, Comprehensive Analysis of the Clinical and Urodynamic Outcomes of Primary Tethered Spinal Cord Before and After Spinal Cord Untethering. J Pediatr Urol, 12(5): 285.e1–285.e5.

Hamano S, Yamanishi T, Igarashi T, et al., 1999, Evaluation of Functional Bladder Capacity in Japanese Children. Int J Urol, 6(5): 226–228.

Ogawa T, 1991, Bladder Deformities in Patients with Neurogenic Bladder Dysfunction. Urol Int, 47(Supp l1): 59–62.

Chang SJ, Van Laecke E, Bauer SB, et al., 2017, Treatment of Daytime Urinary Incontinence: A Standardization Document from the International Children’s Continence Society. Neurourol Urodyn, 36(1): 43–50.

Momose H, 2001, Urinary Drainage and the Autonomic Nervous System. Pathophysiology of dysuria in Various Neurological Disorders. Dysuria in Spina Bifida. Autonomic Nervous System, 38: 99–102.

Foster LS, Kogan BA, Cogen PH, 1990, Bladder Function in Patients with Lipomyelomeningocele. J Urol, 143(5): 984–986.

Keating MA, Rink RC, Bauer SB, et al., 1988, Neurourological Implications of the Changing Approach in Management of Occult Spinal Lesions. J Urol, 140(5 Pt 2): 1299¬¬–1301.

White JT, Samples DC, Prieto JC, et al., 2015, Systematic Review of Urologic Outcomes from Tethered Cord Release in Occult Spinal Dysraphismin Child. Curr Urol Rep, 16(11): 78.

Vernet O, Farmer JP, Houle AM, et al., 1996, Impact of Urodynamic Studies on the Surgical Management of Spinal Cord Tethering. J Neurosurg, 85(4): 555–559.

Guideline Development Committee of The Japan Society for Nocturia, 2016, Guidelines for Nocturia Treatment.

Nakai H, Igawa Y, Taniguchi T, 2020, A Guide to the Treatment and Care of Daytime Urinary Incontinence in Young Children. Journal of the Japanese Society of Paediatric Urology, 29: 3–19.

Austin PF, Bauer SB, Bower W, et al., 2014, The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Update Report from the Standardization Committee of the International Children’s Continence Society. Neurourol Urodyn, 35(4): 471–481.

Tuite GF, Thompson DNP, Austin PF, et al., 2018, Evaluation and Management of Tethered Cord Syndrome in Occult Spinal Dysraphism: Recommendations from the International Children’s Continence Society. Neurourol Urodyn, 37(3): 890–903.

De Gennaro M, Lais A, Fariello G, et al., 1991, Early Diagnosis and Treatment of Spinal Dysraphism to Prevent Urinary Incontinence. Eur Urol, 20(2): 140–145.

Hoffman HJ, Hendrick EB, Humphreys RP, 1976, The Tethered Spinal Cord: Its Protean Manifestations, Diagnosis and Surgical Correction. Childs Brain, 2(3): 145–155.

Pang D, Wilberger JE Jr, 1982, Tethered Cord Syndrome in Adults. J Neurosurg, 57(1): 32–47.

Tamura G, Morota N, Ihara S, 2017, Impact of Magnetic Resonance Imaging and Urodynamic Studies on the Management of Sacrococcygeal Dimples. J Neurosurg Pediatr, 20(3): 289–297.

Wraige E, Borzyskowski M, 2002, Investigation of Daytime Wetting: When is Spinal Cord Imaging Indicated? Arch Dis Child, 87(2): 151–155.

Khoury AE, Hendrick EB, McLorie GA, et al., 1990, Occult Spinal Dysraphism: Clinical and Urodynamic Outcome After Division of the Filum Terminale. J Urol, 144(2): 426–428.

Steinbok P, MacNeily AE, Hengel AR, et al., 2016, Filum Section for Urinary Incontinence in Children with Occult Tethered Cord Syndrome: A Randomized, Controlled Pilot Study. J Urol, 195(4): 1183–1188.

Warder DE, 2001, Tethered Cord Syndrome and Occult Spinal Dysraphism. Neurosurg Focus, 10(1): e1.

Drake JM, 2007, Surgical Management of the Tethered Spinal Cord — Walking the Fine Line. Neurosurg Focus, 23(2): E4.

Finn MA, Walker ML, 2007, Spinal Lipomas: Clinical Spectrum, Embryology, and Treatment. Neurosurg Focus, 23(2): E10.

Hinman F Jr, 1986, Nonneurogenic Neurogenic Bladder (The Hinman syndrome) –15 Years Later. J Urol, 136(4): 769–777.