Pathophysiology of tethered cord syndrome and similar complex disorders.

Tethered cord syndrome (TCS) is a stretch-induced functional disorder of the spinal cord due to the fact that its caudal portion is anchored by an inelastic structure. The functional lesion of TCS is generally situated in the lumbosacral cord, and many authors have shown that the syndrome is reversible via surgery to untether the cord. To clarify the expressions relevant to TCS, such as "cord tethering" and "tethered cord," the authors have formulated three categories.

Urogenital prolapse and occult stress urinary incontinence.

Background: A 76-year-old female presented to an outside clinic with symptoms of pelvic prolapse; she denied stress urinary incontinence (SUI). The patient had a history of two prior anti-incontinence surgeries. Pelvic examination revealed a grade IV cystocele.

Vesicovaginal fistula and mesh erosion after Perigee (transobturator polypropylene mesh anterior repair).

The transobturator polypropylene mesh system is a new approach in the surgical treatment of anterior vaginal wall prolapse. We report the case of a 57-year-old woman who developed a vesicovaginal fistula with erosion of the mesh into the bladder and vagina after Perigee transobturator, polypropylene mesh anterior repair. This is a serious complication associated with this technique.

High rate of vaginal erosions associated with the mentor ObTape.

Purpose: The transobturator tape method is a newer surgical technique for the treatment of stress urinary incontinence. Limited data exist related to complications with this approach or the types of mesh products used. We report our experience with vaginal erosions associated with the Mentor ObTape and American Medical Systems Monarc transobturator slings.

Pathophysiology of tethered cord syndrome and other complex factors.

There are different interpretations of tethered cord syndrome (TCS) partly due to difficulty in understanding the concept of this syndrome as a functional disorder not merely based on gross anatomy of congenital anomalies. The essential mechanical factor of cord tethering is that any of the inelastic structures fastening the caudal end of the spinal cord produces traction effects on the lumbosacral cord. The production of such traction is the key to understanding this disorder.