Concomitant using bulbocavernosus reflex and motor-evoked potential from the external anal sphincter improves continuous monitoring for urinary function assessment during untethering surgery in children.

PURPOSE: Intraoperative monitoring can be used to prevent postoperative urinary dysfunction due to surgical manipulation. However, preoperative neurological dysfunction and young age make monitoring challenging. Therefore, in this study, we evaluated the efficacy of combining two monitoring methods, the bulbocavernosus reflex (BCR) and motor-evoked potential from the external anal sphincter (EAS-MEP) in assessing urinary function in the same pediatric patients during untethering surgery.

METHODS

We retrospectively identified pediatric patients (aged < 6 years) who underwent BCR and EAS-MEP monitoring during untethering surgery between October 2013 and March 2022. Anesthesia was maintained using propofol or sevoflurane/opioid without neuromuscular blockade.

RESULTS

We identified 18 pediatric patients who underwent BCR and EAS-MEP monitoring during untethering surgery. Our results showed that the baseline success rates were 78%, 61%, and 89% for BCR, EAS-MEP, and the concomitant use of BCR and EAS-MEP, respectively. Furthermore, of the 18 pediatric patients, the two patients with new urinary dysfunction required postoperative urinary catheterization, and the three patients with worsened preoperative urinary dysfunction showed an increased frequency of catheterization. The accuracy of the BCR and EAS-MEP monitoring for the same patients was 93% and 91%, respectively.

CONCLUSION

The accuracy of BCR and EAS-MEP monitoring is similar in pediatric untethering surgery, and the concomitant use of BCR and EAS-MEP improves continuous intraoperative monitoring compared with using only one method.