Does selective dorsal rhizotomy improve bladder function in children with cerebral palsy?

Purpose: To investigate the efficacy of selective dorsal rhizotomy (SDR) on urinary symptoms and bladder function in cerebral palsy children.

Methods: Selective dorsal rhizotomy was performed in 56 children with spastic cerebral palsy. Intraspinal nerve root divisions over the cauda equina from L1/2 to S1/2 levels were performed. Urinary symptoms and urodynamic study (UDS) parameters before and after SDR were analyzed.

Results: Fifty-four out of 56 children (mean age 7.7) with SDR performed had complete urinary symptoms for analysis, of which 90 % had diplegic cerebral palsy. Fifty-one children had preoperative UDS performed, and 20 children had both preoperative and postoperative UDS. All UDS were performed within 4 weeks before SDR, and the mean time from SDR to post-op UDS was 8.4 months. Before operation, 22 out of 54 (40.7 %) children had urgency or frequency, and 16 out of 54 (29.6 %) children had incontinence. Twelve out of 22 (54.5 %) children with urgency or frequency became completely asymptomatic after SDR (p = 0.013), while 9 out of the 10 children with residual urgency or frequency had significant improvement. Twelve out of 16 (75.0 %) incontinent children became continent after SDR (p = 0.013). Bladder capacity at first incontinence significantly increased from 70 to 130 ml (p = 0.016). Other parameters had no significant difference after SDR. There was a trend that S2 rootlet division had major contribution in achieving continence.

Conclusions: Selective dorsal rhizotomy significantly improved urgency, frequency, incontinence, and urodynamic bladder capacity at first incontinence in a significant proportion of spastic cerebral palsy children.