Presentation Authors: Shenelle Wilson*, L. Keith Lloyd, Tracey Wilson, Birmingham, AL
Introduction: As management of patients with spina bifida (SB) has improved over the years, more patients are surviving into adulthood. Lifelong urologic care is necessary to monitor unfavorable bladder parameters and prevent renal damage. During the pediatric years, urodynamic testing (UDS) is routinely performed. The need for and frequency of this testing in adult SB patients remains unknown. We reviewed our utilization of UDS in adults with SB to determine appropriate indications and to assess the effect of UDS on treatment decisions.
Methods: A retrospective chart review was conducted of 234 consecutive patients seen in our Adult Multidisciplinary Spina Bifida Clinic and registered with the National Spina Bifida Patient Registry (NSBPR) from October 2011 to October 2018. Of these patients, 75 have undergone UDS. Five of these patients were excluded due to a missing or incomplete treatment plan after the UDS. Seven of the remaining patients underwent UDS twice, resulting in a total of 77 UDS encounters that were analyzed for this study.
Results: Almost 32% of the patients treated in the Spina Bifida Clinic have received UDS. 43% of them required UDS for a change in their voiding habits, 16% required UDS for declining renal function or change in upper tract imaging. Of the patients who underwent UDS, 74% of them received a new recommendation in the management of their neurogenic bladder and 39% of them were recommended to receive surgical intervention.
Conclusions: Although spinal dysraphism is not considered a progressive neurologic disorder, bladder function may change over time. As more patients with SB enter adulthood, it is important for urologists to recognize the signs and symptoms associated with that change. This study illustrates the importance of UDS in adults with SB and the likelihood that the UDS findings may indicate a need for change in bladder management.