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Contemporary Urologic Management of Adult Spina Bifida Patients
Jessica T. Casey, MS, MD1, Alyssa Greiman, BS1, Kalen Rimar, MD1, Shubhra Mukherjee, MD2, Stephanie J. Kielb, MD1.
1Northwestern University, Chicago, IL, USA, 2Rehabilitation Institute of Chicago, Chicago, IL, USA.

Introduction: Patients with spina bifida require multi-specialty medical care throughout their lives. There are relatively few studies describing urologic management and outcomes of adult spina bifida patients or their risk of developing potentially related co-morbid conditions. By understanding the adult population, pediatric urologists can provide better counseling and preventative care for pediatric and adolescent patients with spina bifida.
Materials & Methods: A retrospective chart review of patients seen in our adult spina bifida clinic from January 2004 to November 2011 was performed to identify urologic management, urologic surgeries, and co-morbidities.
Results: 225 patients were identified (57.8% female, 42.2% male). Current average age was 32.7 years (SD 9.24) with an average age at first visit of 27.6 years (SD 9.13). The majority (86.7%) were diagnosed with myelomeningocele with 36.3% thoracic or high lumbar, 44.1% lumbar, 19.6% sacral lesion levels. The majority (70.7%) utilized clean intermittent catheterization, and 111 patients (49.3%) were prescribed anticholinergic medications. 66% had urodynamics performed at least once, and 56% obtained appropriate upper tract imaging at least every other year while under our care. 79 patients (35.1%) underwent at least one urologic surgical procedure, of which continence procedures (n=46, 20.4%) were most common. Other procedures included augmentation cystoplasty (n=29, 12.9%) and stone procedures (n=27, 12%). Only 3.6% had a documented diagnosis of chronic kidney disease and 0.9% with end-stage renal disease. The most common recorded co-morbidities were obesity (body mass index (BMI)>30) 27.1%), nephrolithiasis (14.2%), hypertension (11.1%), gastro-esophageal reflux (5.3%), seizure disorders (5.3%) and diabetes (4.0%). Additionally, two patients (0.9%) were diagnosed with invasive bladder cancer while followed in our clinic.
Conclusion: Most adult spina bifida patient continue on anticholinergic medications and clean intermittent catheterization. We observed a high incidence of stone disease in this patient population, likely secondary urinary stasis, chronic bacteriuria and irritation from catheterization. Ongoing efforts need to be made on the smooth transition of adolescent spina bifida patients to an adult clinical setting with close monitoring for high incidence and high-risk co-morbidities such as obesity, diabetes, end-stage renal disease, and bladder cancer.


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