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A case of undiagnosed tethered cord syndrome aggravated by transurethral prostate resection

Nature Clinical Practice Urology volume 2, pages 199–204 (2005)Cite this article

Abstract

Background A 68-year-old man presented with a history of significant urinary urge incontinence, pollakiuria, and weak bladder sensation. He also reported mild fecal incontinence and a hypotrophic and slightly weaker left leg. At 63 years of age he had presented to a urologist for treatment of irritative lower urinary tract symptoms and incontinence. A transurethral resection of the prostate had been performed. After the operation, the symptoms had persisted and the incontinence seriously worsened.

Investigations Clinical neurologic examination, videourodynamic examination, neurophysiologic examination, and MRI of the spinal cord.

Diagnosis Neurogenic bladder dysfunction caused by adult tethered cord syndrome with myelon up to S2 level, spina bifida occulta, and lipoma infiltrating the conus medullaris.

Management Conservative anticholinergic treatment failed, and injection of botulinum-A toxin is planned.

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Figure 1: Cystometry chart during the ice-water test showed a strong involuntary contraction of the bladder up to a pressure of 240 cm H2O after 1 minute.
Figure 2: Filling cystometry chart.
Figure 3: T2-weighted sagittal MRI of the lower spinal cord.
Figure 4: T1-weighted axial MRI of the sacrum.
Figure 5: Examination algorithm.

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Author information

Authors and Affiliations

  1. research fellow in Neuro-Urology at Balgrist University Hospital, Switzerland

    Sönke Boy

  2. clinical fellow in Urology at the University of Heidelberg, Germany

    André Reitz

  3. consultant in Clinical Neurophysiology at Balgrist University Hospital, Switzerland

    Armin Curt

  4. head of the department of Neuro-Urology at the Swiss Paraplegic Centre, Balgrist University Hospital, Switzerland

    Brigitte Schurch

Authors
  1. Sönke Boy
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  2. André Reitz
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  3. Armin Curt
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  4. Brigitte Schurch
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Corresponding author

Correspondence to Sönke Boy.

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Competing interests

The authors declare no competing financial interests.

Glossary

HYPESTHESIA

Diminished ability to perceive tactile stimuli

HYPALGESIA

Diminished ability to perceive painful stimuli

CONUS MEDULLARIS

The cone-shaped lower end of the spinal cord

SPINA BIFIDA OCCULTA

A congenital condition representing a set of 'covered' spinal cord lesions that include intraspinal lipoma, lipomyelomeningocele, split cord malformation, meningocele manqué, ectodermal inclusion tumor or cyst, neurenteric cyst and tight filum terminale

FILUM TERMINALE

Threadlike appendage to the lower spinal cord

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Boy, S., Reitz, A., Curt, A. et al. A case of undiagnosed tethered cord syndrome aggravated by transurethral prostate resection. Nat Rev Urol 2, 199–204 (2005). https://doi.org/10.1038/ncpuro0140

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