From the Guidelines
Tethered cord syndrome in adults can cause various urologic symptoms, including urinary incontinence, frequency, and recurrent urinary tract infections, which can be assessed by history, imaging, and formal urodynamic testing 1. These symptoms occur due to the abnormal stretching of the spinal cord, which disrupts normal nerve pathways controlling bladder function.
Common Urologic Symptoms
- Urinary incontinence
- Frequency
- Recurrent urinary tract infections
- Neurogenic bladder dysfunction
Diagnosis and Assessment
Diagnosis typically involves assessing urologic function by history, imaging (such as renal ultrasonography), and formal urodynamic testing to evaluate the bladder's response to retrograde filling 1.
Treatment and Management
Treatment primarily consists of surgical untethering of the spinal cord when symptoms are progressive or severe.
- Conservative management includes clean intermittent catheterization for retention
- Anticholinergic medications like oxybutynin or tolterodine for overactive bladder symptoms
- Alpha-blockers such as tamsulosin for outflow obstruction
- Prophylactic antibiotics may be needed for recurrent UTIs Early diagnosis and treatment are crucial as urologic symptoms may become irreversible if intervention is delayed 1.
Follow-up and Monitoring
Regular urologic follow-up with periodic urodynamic testing is recommended to monitor bladder function even after surgical intervention, as some patients may experience symptom recurrence due to retethering.
From the Research
Urologic Symptoms of Tethered Cord Syndrome in Adults
The urologic symptoms of tethered cord syndrome in adults include:
- Urgency and urge incontinence, which were the most common findings in 67% and 50% of patients, respectively 2
- Impaired detrusor contractility, which was the most common urological symptom in 73% of patients 3
- Voiding difficulty, which was present in 30% of patients 4
- Stool soilage, which was present in 27% of patients 4
- Pollakiuria, which was present in 30% of patients 4
- Urgency and symptomatic urinary tract infection, which were present in 34% of patients 4
Urodynamic Findings
Urodynamic findings in adults with tethered cord syndrome include:
- Hyperreflexia, which was present in 72% of patients 2
- External detrusor-sphincter dyssynergia, which was present in 22% of patients 2
- Decreased sensation, which was present in 22% of patients 2
- Decreased compliance, which was present in 17% of patients 2
- Hypocontractile detrusor, which was present in 11% of patients 2
- Detrusor areflexia, which was predominant in 60% of patients 3
Treatment Outcomes
Treatment outcomes for adults with tethered cord syndrome include:
- Improvement in urinary symptoms in 19% of patients 2
- Improvement in urodynamic findings in 29% of patients 2
- Resolution of external detrusor-sphincter dyssynergia in 3 out of 4 patients 2
- Improvement in clinical symptomatology and urodynamic parameters in 67.0% and 49.0% of patients, respectively 4
- Better improvement in patients treated promptly by neurosurgical intervention 4