COMPARISON OF SECTION OF FILUM TERMINALE AND NON-NEUROSURGICAL MANAGEMENT FOR URINARY INCONTINENCE IN PATIENTS WITH NORMAL CONUS POSITION AND POSSIBLE OCCULT TETHERED CORD SYNDROME
Bibliographic record
Abstract
OBJECTIVE: Patients with persistent urinary incontinence and a normal location of the conus on magnetic resonance imaging scans may have occult tethered cord syndrome (OTCS). We compare outcomes in such patients after filum section versus nonoperative treatment. METHODS: We performed a retrospective analysis of a consecutive series of children with refractory urinary incontinence and normal location of the conus who were offered section of the filum for treatment of possible OTCS. RESULTS: Eight children, aged 4.4 to 9.8 years, underwent filum section, with one child undergoing two such operations. Clinical urological improvement occurred in seven children at a mean follow-up period of 3.1 years, with improved urodynamic findings in four of the seven children tested postoperatively. Other non-urological back or lower limb abnormalities improved in five out of six children with such findings. None of the patients underwent additional urological operations after filum section. Seven children, aged 3.1 to 13.5 years, all of whom had abnormal urodynamic findings, did not undergo filum section. At a mean follow-up period of 3.3 years, two patients had urological improvement and three patients had undergone bilateral ureteric reimplantations. Other non-urological back and/or lower limb abnormalities were present in five patients and did not improve. One patient had the filum cut after 8 years and improved thereafter. CONCLUSION: Section of the filum in children with refractory urinary incontinence and OTCS may produce better urological outcomes than continued medical management. A definitive answer to the question of whether section of the filum is better than non-neurosurgical medical management for children with OTCS awaits the conclusion of a randomized controlled trial.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".