Presentation Authors: Mehdi EL AKRI, Charlène Brochard, Juliette Hascoet, Magali Jezequel, Quentin Alimi, Zine-Eddine Khene, Claire Richard, Isabelle Bonan, Jacques Kerdraon, Rennes, France, Xavier Gamé, Toulouse, France, Andrea Manunta, Laurent Siproudhis, Benoît Peyronnet*, Rennes, France
Introduction: To assess the relative risks of pelvic organ prolapse (POP) and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor voiding with Valsalva versus those using clean-intermittent catheterization (CIC).
Methods: We conducted a retrospective analysis including all spina bifida patients with neurogenic acontractile detrusor with a minimum follow-up of 12 months. Patients were then divided in two groups according to their bladder management: voiding with Valsalva versus CIC. The primary endpoint was any de novo or worsened rectaland/or pelvic organ prolapse (POP) diagnosed during follow-up. The secondary outcome was urinary complications defined as febrile urinary tract infections (UTI) and/or urolithiasis and/or renal failure.
Results: Fifty-five patients (50.9% were males) met the inclusion/exclusion criteria: 28 voiding with Valsalva and 27 performing CIC. At baseline, the rates of vaginal prolapse (44.4% vs 50%;P=0.99), and rectal prolapse/intussusception(25.9%vs 21.4%;P=0.76) were similar in both groups. After a median follow-up of 80.6 and 65.6 months, respectively (P=0.29), the rate of de novo or worsened rectal prolapse/intussusception was higher in the Valsalva voiding group than in the CIC group(32.1%vs3.7%;P=0.01). De novo or worsened vaginal prolapses were also more common in the Valsalva voiding group, but it did not reach statistical significance (33.3% vs 11.1%; P=0.29).
Conclusions: Valsalva voiding might be harmful in adult spina bifida patients with neurogenic acontractile detrusor as it may increase the risk of rectal prolapse/ intussusception. Overall,the prevalence of POP and rectal prolapse was high in both groups.