Storage‐Pressure Urodynamic Risk in Children With Radiological Suspicion of Tethered Spinal Cord: A Single‐Center Retrospective Comparative Study

OBJECTIVE: To compare unsafe storage-pressure urodynamic findings in children with radiological suspicion or confirmation of tethered spinal cord and in clinically referred children without radiological tethering. MATERIALS AND METHODS: This single-center retrospective comparative study included children aged 2-18 years who underwent urodynamic testing between October 2024 and December 2025 and had available spinal magnetic resonance imaging. Of 172 children assessed, 52 were excluded because spinal MRI was unavailable. The final cohort included 120 children: 60 with radiological tethering and 60 without tethering. The primary outcome was an unsafe storage-pressure urodynamic pattern. Post-void residual urine was excluded from the primary composite outcome and analyzed separately. RESULTS: Age and sex were comparable between groups. Unsafe storage-pressure urodynamics were more frequent in the radiological tethered cord group than in the non-tethered comparison group (48.3% vs. 21.7%, p = 0.003). Low compliance, elevated end-filling pressure, high-pressure detrusor overactivity, detrusor-sphincter dyssynergia, and increased post-void residual urine were also more common. MRI and urodynamic risk were not fully concordant: 51.7% of children with radiological tethering had safe storage-pressure urodynamics, whereas 21.7% without tethering had unsafe findings. Radiological tethering alone demonstrated a sensitivity of 69.0%, specificity of 60.3%, positive predictive value of 48.3%, and negative predictive value of 78.3% for unsafe storage-pressure urodynamics. In multivariable analysis, radiological tethering, increased post-void residual urine, and hydronephrosis were independently associated with unsafe storage-pressure urodynamics. CONCLUSIONS: Radiological tethering was associated with unsafe storage-pressure urodynamic findings, but MRI alone did not define functional bladder safety. Increased post-void residual urine and hydronephrosis may identify children at higher risk; however, these findings are hypothesis-generating and do not establish a validated pathway for safely withholding urodynamic testing.