Urological Concerns of Occult Spinal Dysraphism/Tethered Cord

Urologic manifestation, evaluation, and management of a child with a tethered cord secondary to occult spinal dysraphism are not clearly understood. There are no strong evidence-based studies that help guide the pediatric urologist. This chapter reviews the basic understanding of occult spinal dysraphism and its potential impact on urinary bladder dynamics and symptomatic voiding dysfunction. The foundation of management often centers on urodynamic testing which provides objective assessment of urinary bladder function. The urodynamic study helps define current status directing active management and provides a baseline that can be utilized to place in perspective changes that might be occurring because of the progression of cord tethering. The potential need for operative intervention of the tethered cord due to occult spinal dysraphism based on urologic symptoms or urodynamic parameters will be discussed along with the expected outcome.