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Urologic follow-up in adult spina bifida patients
Jon Duplisea, MD, Rodrigo Romao, MD, Dawn MacLellan, MD, Ashley Cox, MD, Peter Anderson, MD.
Dalhousie University, Halifax, NS, Canada.

Background: The International Children's Continence Society (ICCS) recommends follow-up every 3 years for adult SB patients, however little data exist on the topic. Our goal was to investigate the ideal follow-up interval for these patients based on the development of urological issues over time.
Methods: Retrospective review of records from a multidisciplinary adult SB clinic in a tertiary center. Patient age, sex, voiding pattern (CIC or not), number of clinic visits and length of follow-up were recorded. For each unique visit, presence of symptoms, type of urological issues (if any) requiring intervention, and time lapsed since last appointment were obtained. The interval between the development of urological issues was assessed using a time-to-event analysis.
Results: Data on 123 patients (46%M,54%F) and 586 unique clinic visits were collected. Median age, length of follow-up and number of clinic visits were 26.8 years(range 18-67), 48 months(0-321) and 4 visits(1-20), respectively. Urological issues were identified in 267 visits (46%) and of those 21% were asymptomatic (p<0.0001). The most common urological issues were incontinence (29%), urinary tract infection (25%), and stones (19%). In symptomatic patients, the median time to present with a urological issue was 12 months and 83% had become symptomatic by 2 years of follow-up. Among the asymptomatic cases, 12, 23 and 40% had developed urological issues at 12, 24 and 36 months of follow-up, respectively. The only variable significantly associated with the development of urological issues on Cox proportional hazards analysis was the presence of symptoms (Hazard Ratio 6.8; p<0.0001; age, sex and voiding pattern not significant).
Conclusions: Most adult SB patients (>80%) with urological issues are symptomatic by 2 years of f/u, however over time the proportion of asymptomatic patients with urological issues rises steadily reaching a worrisome 40% at 3 years. Hence, the 3-year follow-up interval suggested by ICCS seems long and may pose risks. Based on our data, it may be prudent to recommend shortening the follow-up interval to every 12 to 18 months.

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