Intraoperative rectal ampullar manometry in spinal cord conus lipoma surgery in children

Objective. To assess a potential of using intraoperative rectal ampullar manometry to prevent bladder dysfunction in surgical treatment of the  spinal cord conus lipoma.

Material and Methods. The  results of surgical treatment of 59 children with lipomas of the  spinal cord  conus were studied. The  presence of urological symptoms (urinary retention or incontinence) was  assessed before and  after surgery. Intraoperative rectal ampullar manometry was performed in 22 cases with registration of signs of irritation (increased pressure in the  rectal ampulla) and depression (decreased pressure in the  rectal ampulla) of sacral parasympathetic centers which allowed controlling their proximity and tolerance to the performed manipulations.

Results. Urological symptoms before surgery were  detected in 25 (42 %)  patients: urinary retention in 7 (28 %),  and  incontinence in 18 (72 %).  Symptoms were  significantly more often detected in children older  than 3 years (p < 0.05). Intraoperatively, a transient decrease in pressure in the  rectal ampulla was noted during bipolar coagulation, and a decrease in pressure in the  rectal ampulla was noted during ultrasound disintegration. The  most pronounced changes in pressure were observed during manipulations along the borderline between the lipoma and the spinal cord in the zone of localization of sacral parasympathetic centers. Persistent profound changes in pressure (>3 mm Hg) have precluded from the total removal of lipoma in all 22 patients; subtotal or partial lipoma removal and  release of the tethered spinal cord were achieved in all cases. None of the patients operated on using rectal ampullar manometry presented urinary retention after surgery, these disorders developed in 12 (32 %) children operated on without this procedure (p < 0.05).

Conclusion. Paresis or paralysis of the  bladder detrusor after removal of the  spinal cord  conus lipoma may result from  direct damage to the  parasympathetic sacral centers located at the  borderline between the  lipoma and the  spinal cord.  The  method of intraoperative rectal ampullar manometry allows protecting the  functions of the  pelvic organs and determining the  safe volume of lipoma resection.

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