STEVE INSKEEP, host:
Now, here is one of the terrors of childhood. Some kids fear that they will wet their pants at school. In Portland, Oregon, a pediatric neurosurgeon is helping some kids for whom this fear is a daily reality, and she explained the procedure to NPR's Jane Greenhalgh.
JANE GREENHALGH reporting:
When Monica Wehby was in her first year of private practice at Emmanuel Hospital, she started doing a controversial operation on children who couldn't control their bowel and bladder.
Dr. MONICA WEHBY (Pediatric Surgeon): It was so exciting the way that it was working, and I was surprised by the results were almost unbelievable for me. I'm looking at this and like, how can this be? You know, either all of these people are coming back in and lying to me, or this really works.
GREENHALGH: It was 1997, and very unusual for a neurosurgeon to operate on children whose main problem was incontinence. Only a few surgeons were doing the procedure at the time. But as Monica Wehby did more of these surgeries, she found that over 90 percent of her patients dramatically improved, and many regained complete control.
Dr. WEHBY: And I remember looking at my data when I was going to present it, and I remember thinking nobody is going to believe it. You know, if I stand up there and say this, they're going to think I'm crazy.
GREENHALGH: Some colleagues did criticize her for trying to solve incontinence with neurosurgery. A lot of her patients had been told their problem was psychological, or they'd grow out of it. Now, tethered cord surgery has become an accepted operation for the small group of children whose incontinence can be directly linked to this neurological problem.
Dr. WEHBY: So, this is our spinal cord. So, this is lumbar 5, 4, 3, 2...
GREENHALGH: Monica Wehby points to the x-ray of a seven-year-old girl, whose spinal cord ends in a slight abnormality.
Everyone's spinal cord ends with a small piece of scar tissue called a filum. In most cases, it's stretchy and elastic. But in some people, it's not.
Dr. WEHBY: And you can actually see nicely her little filum, here. See how this kind of pulls back?
GREENHALGH: A tight filum, one that doesn't stretch, can cause enormous problems. As a child grows, it pulls on the bottom of the spinal cord and disrupts the nerves at the end of the spinal column. The nerves that control the bowel and bladder.
Dr. WEHBY: It's heartbreaking, some of the stories you hear, that, you know, nobody wants to play with the child, or nobody will come to their birthday party, or people are making fun of them because they smell like urine or stool. And for these children not to be able to control something as basic as peeing and pooping in their pants is just psychologically devastating for them.
Okay. Have we gotten loopy enough yet, princess?
GREENHALGH: In about 30 minutes, Monica Wehby will help this little girl regain control of her bowel and bladder, and her self-esteem.
Dr. WEHBY: And so, right now what I'm doing is doing down through the fasciae, which, you know, lines the muscle. So, we dissect the muscle off and pull it out to the side. Our goal is to get down to the spinal fluid sac. These yellow things are the nerve roots bouncing around, and the filum is that white string that's tighter--comes in and out with a pulsation. So here it is, right here. And we just cut it with this little bitty tiny pair of scissors. See how it just twangs out, because it's tight? That's the whole operation, that's all there is to it.
GREENHALGH: About half an hour later, this little girl is off to the recovery room. Dr. Wehby will get ready for another surgery.
Dr. WEHBY: I think that this was my contribution, what I was supposed to do in this field, because it has been so challenging and has taken so much out of me emotionally and professionally to stay the course and keep doing what I knew was working. And facing criticism and not giving up, and I'm so happy that I have.
GREENHALGH: As a pediatric neurosurgeon, Monica Wehby performs many more complicated operations: brain tumors, facial reconstructions. But this little procedure, she says, is one of her favorites, because it's so simple and yet makes such a huge difference for these children and their families.
Jane Greenhalgh, NPR News, Portland, Oregon.
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