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Nisheljeet S, Azizi AB, Palaniandy K, Ganesan D, Ong TA, Alias A, Rajamanickam R, Atroosh WM, Mohd-Zin SW, Lee-Shamsuddin A, Nivrenjeet S, Lo W, Abdul-Aziz NM. Survey on Untethering of the Spinal Cord and Urological Manifestations among Spina Bifida Patients in Malaysia. CHILDREN 2022; 9:children9071090. [PMID: 35884073 PMCID: PMC9324435 DOI: 10.3390/children9071090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
Abstract
The incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other neurological problems. It occurs in patients with spina bifida, and the authors of this study sought to investigate the impact of untethering on the urological manifestations of children with a tethered cord, thereby consolidating a previously known understanding that untethering improves bladder and bowel function. Demographic and clinical data were collected via an online questionnaire and convenient sampling techniques were used. A total of 49 individuals affected by spina bifida participated in this study. UTIs were reported based on patients’ observation of cloudy and smelly urine (67%) as well as urine validation (60%). UTI is defined as the combination of symptoms and factoring in urine culture results that eventually affects the UTI diagnosis in spina bifida individuals irrespective of CISC status. Furthermore, 18% of the respondents reported being prescribed antibiotics even though they had no history of UTI. Therefore, indiscriminate prescription of antibiotics by healthcare workers further compounds the severity of future UTIs. Employing CISC (73%) including stringent usage of sterile catheters (71%) did not prevent patients from getting UTI. Overall, 33% of our respondents reported manageable control of UTI (0–35 years of age). All individuals below the age of 5 (100%, n = 14) were seen to have improved urologically after the untethering surgery under the guidance of the Malaysia NTD support group. Improvement was scored and observed using KUB (Kidneys, Ureters and Bladder) ultrasound surveillance before untethering and continued thereafter. Spina bifida individuals may procure healthy bladder and bowel continence for the rest of their lives provided that neurosurgical and urological treatments were sought soon after birth and continues into adulthood.
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Affiliation(s)
- Singh Nisheljeet
- Invertebrate & Vertebrate Neurobiology Lab, Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.N.); (S.W.M.-Z.); (A.L.-S.); (S.N.)
| | - Abu Bakar Azizi
- Department of Surgery, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (A.B.A.); (K.P.)
| | - Kamalanathan Palaniandy
- Department of Surgery, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (A.B.A.); (K.P.)
| | - Dharmendra Ganesan
- Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (D.G.); (T.A.O.)
| | - Teng Aik Ong
- Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (D.G.); (T.A.O.)
| | - Azmi Alias
- Department of Neurosurgery, Tunku Abdul Rahman Neuroscience Institute (IKTAR), Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia;
- Department of Pediatric Neurosurgery, Women and Children Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia
| | | | - Wahib M. Atroosh
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Siti Waheeda Mohd-Zin
- Invertebrate & Vertebrate Neurobiology Lab, Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.N.); (S.W.M.-Z.); (A.L.-S.); (S.N.)
| | - Andrea Lee-Shamsuddin
- Invertebrate & Vertebrate Neurobiology Lab, Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.N.); (S.W.M.-Z.); (A.L.-S.); (S.N.)
| | - Singh Nivrenjeet
- Invertebrate & Vertebrate Neurobiology Lab, Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.N.); (S.W.M.-Z.); (A.L.-S.); (S.N.)
| | - Warren Lo
- Department of Urology, Kuala Lumpur Hospital, Jalan Pahang, Kuala Lumpur 50586, Malaysia
- Correspondence: (W.L.); (N.M.A.-A.)
| | - Noraishah Mydin Abdul-Aziz
- Invertebrate & Vertebrate Neurobiology Lab, Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.N.); (S.W.M.-Z.); (A.L.-S.); (S.N.)
- Correspondence: (W.L.); (N.M.A.-A.)
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Moussa M, Papatsoris AG, Chakra MA, Fares Y, Dabboucy B, Dellis A. Perspectives on urological care in spina bifida patients. Intractable Rare Dis Res 2021; 10:1-10. [PMID: 33614369 PMCID: PMC7882087 DOI: 10.5582/irdr.2020.03077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/04/2020] [Accepted: 12/12/2020] [Indexed: 02/05/2023] Open
Abstract
Spina bifida (SB) is a neurogenetic disorder with a complex etiology that involves genetic and environmental factors. SB can occur in two major forms of open SB or SB aperta and closed SB or SB occulta. Myelomeningocele (MMC), the most common neural tube defects (NTDs), occurs in approximately 1 in 1,000 births. Considering non-genetic factors, diminished folate status is the best-known factor influencing NTD risk. The methylenetetrahydrofolate reductase (MTHFR) gene has been implicated as a risk factor for NTDs. The primary disorder in the pathogenesis of MMC is failed neural tube closure in the embryonic spinal region. The clinical manifestation of SB depends on clinical type and severity. SB can be detected in the second trimester using ultrasound which will reveal specific cranial signs. The management of MMC traditionally involves surgery within 48 h of birth. Prenatal repair of MMC is recommended for fetuses who meet maternal and fetal Management of Myelomeningocele Study (MOMS) specified criteria. Urological manifestations of SB include urinary incontinence, urolithiasis, sexual dysfunction, renal dysfunction, and urinary tract infection. Renal failure is among the most severe complications of SB. The most important role of the urologist is the management of neurogenic bladder. Medical management with clean intermittent catheterization and anticholinergic treatment is generally considered the gold standard of therapy. However, when this therapy fails surgical reconstruction become the only remaining option. This review will summarize the pathogenesis, risk factors, genetic contribution, diagnostic test, and management of SB. Lastly, the urologic outcomes and therapies are reviewed.
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Affiliation(s)
- Mohamad Moussa
- Urology Department, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios G. Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Athanasios Dellis
- Department of Urology/General Surgery, Areteion Hospital, Athens, Greece
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Lifelong Congenital Urology: The Challenges for Patients and Surgeons. Eur Urol 2019; 75:1001-1007. [PMID: 30935758 DOI: 10.1016/j.eururo.2019.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/13/2019] [Indexed: 11/22/2022]
Abstract
CONTEXT Patients born with complex congenital genitourinary anomalies (including bladder exstrophy, cloacal exstrophy, epispadias, neurogenic bladder, hypospadias and posterior urethral valves) often require major reconstructive surgery in childhood. These conditions, their treatment and sequelae require lifelong follow-up. This has created the need for adult urologists to provide care as these patients grow into adults. OBJECTIVE To evaluate current strategies for transition and provide a current position statement with examples of the challenges faced by patients and their health care teams as a result of these conditions and their treatment. EVIDENCE ACQUISITION Each of the authors was asked to provide a 500-word synthesis, based on current literature; to highlight the challenges faced in an area of their expertise. EVIDENCE SYNTHESIS The authors assembled in March 2018 to form a consensus based on the data gathered. The aforementioned sections were reviewed and following the consensus discussion the paper was formulated and reviewed. CONCLUSIONS Lifelong care of congenital problems is challenging and essential for many but not all. Expertise is needed to provide the best care for patients and make the best use of resources. Specialist centres appear to be the most effective and safe model. In the long term it would be ideal to establish an evidence base focused on the common long-term problems with these conditions to ensure excellent care with appropriate expertise. PATIENT SUMMARY Patients born with complex congenital anomalies of the genitourinary system require specialist care in childhood. Many will need lifelong care to manage their condition and the treatment of it. There is growing interest in this area of medicine and this consensus statement addresses the need for lifelong care in this group. The aim is to ensure that all patients that need care at any age are able to find what they need.
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Skokan AJ, Kovell RC. Advances and Challenges in Transitional Urology: Caring for Adolescents and Young Adults with Lifelong Complex Genitourinary Conditions. Curr Urol Rep 2018. [PMID: 29516272 DOI: 10.1007/s11934-018-0774-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW As long-term survival with complex congenital and pediatric diseases has improved, more patients with congenital genitourinary conditions are living into adulthood. These patients can continue to face lifelong issues related to their conditions, including urinary incontinence, recurrent urinary tract infections, chronic kidney disease, and difficulties with sexual health and function. RECENT FINDINGS The practice of transitional urology continues to grow nationwide and abroad, and it will be important to develop evidence-based practices for coordinated transition of these patients into the adult health care setting. This review describes the broader attention to transitions of care in medicine and specifically evaluates spina bifida as a model disease system for implementation of transitional practices in urology.
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Affiliation(s)
- Alexander J Skokan
- Division of Urology, University of Pennsylvania Health System, 3400 Civic Center Blvd, 3rd Floor - West Pavilion, Philadelphia, PA, 19104, USA
| | - Robert Caleb Kovell
- Division of Urology, University of Pennsylvania Health System, 3400 Civic Center Blvd, 3rd Floor - West Pavilion, Philadelphia, PA, 19104, USA. .,University of Pennsylvania Health System and the Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Brochard C, Ropert A, Peyronnet B, Ménard H, Manunta A, Neunlist M, Bouguen G, Siproudhis L. Fecal incontinence in patients with spina bifida: The target is the rectum. Neurourol Urodyn 2017; 37:1082-1087. [DOI: 10.1002/nau.23417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/07/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Charlène Brochard
- Service des Maladies de l'Appareil Digestif; CHRU Pontchaillou, Université de Rennes 1; Rennes France
- Service d'Explorations Fonctionnelles Digestives, CHRU Pontchaillou; Université de Rennes 1; Rennes France
- INSERM U1235; Université de Nantes; Nantes France
- CIC 1414, INPHY; Université de Rennes 1; Rennes France
| | - Alain Ropert
- Service d'Explorations Fonctionnelles Digestives, CHRU Pontchaillou; Université de Rennes 1; Rennes France
| | - Benoît Peyronnet
- CIC 1414, INPHY; Université de Rennes 1; Rennes France
- Service d'Urologie; CHRU Pontchaillou; Rennes France
| | - Hélène Ménard
- Centre Référence National Maladies Rares Spina Bifida; CHRU Pontchaillou; Rennes France
| | - Andréa Manunta
- Service d'Urologie; CHRU Pontchaillou; Rennes France
- Centre Référence National Maladies Rares Spina Bifida; CHRU Pontchaillou; Rennes France
| | | | - Guillaume Bouguen
- Service des Maladies de l'Appareil Digestif; CHRU Pontchaillou, Université de Rennes 1; Rennes France
- CIC 1414, INPHY; Université de Rennes 1; Rennes France
- INSERM 1241; Université de Rennes; Rennes France
| | - Laurent Siproudhis
- Service des Maladies de l'Appareil Digestif; CHRU Pontchaillou, Université de Rennes 1; Rennes France
- CIC 1414, INPHY; Université de Rennes 1; Rennes France
- Centre Référence National Maladies Rares Spina Bifida; CHRU Pontchaillou; Rennes France
- INSERM 1241; Université de Rennes; Rennes France
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Groah SL, Pérez-Losada M, Caldovic L, Ljungberg IH, Sprague BM, Castro-Nallar E, Chandel NJ, Hsieh MH, Pohl HG. Redefining Healthy Urine: A Cross-Sectional Exploratory Metagenomic Study of People With and Without Bladder Dysfunction. J Urol 2016; 196:579-87. [PMID: 26807926 DOI: 10.1016/j.juro.2016.01.088] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE We used the PathoScope platform to perform species level analyses of publicly available, 16S rRNA pyrosequenced, asymptomatic urine data to determine relationships between microbiomes, and clinical and functional phenotypes. MATERIALS AND METHODS We reanalyzed previously reported, cross-sectionally acquired urine samples from 47 asymptomatic subjects, including 23 controls and 24 subjects with neuropathic bladder. Urine was originally collected by the usual method of bladder drainage and analyzed by urinalysis, culture and pyrosequencing. Urinalysis and culture values were stratified as leukocyte esterase (0, or 1 or greater), nitrite (positive or negative), pyuria (fewer than 5, or 5 or greater white blood cells per high power field), cloudy urine (positive or negative) and urine culture bacterial growth (less than 50,000, or 50,000 or greater cfu/ml). PathoScope was used for next generation sequencing alignment, bacterial classification and microbial diversity characterization. RESULTS Subjects with neuropathic bladder were significantly more likely to have positive leukocyte esterase and pyuria, cloudy urine and bacterial growth. Of 47 samples 23 showed bacterial growth on culture and in all samples bacteria were identified by pyrosequencing. Nonneuropathic bladder urine microbiomes included greater proportions of Lactobacillus crispatus in females and Staphylococcus haemolyticus in males. The Lactobacillus community differed significantly among females depending on bladder function. Irrespective of gender the subjects with neuropathic bladder had greater proportions of Enterococcus faecalis, Proteus mirabilis and Klebsiella pneumonia. In 4 subjects with neuropathic bladder Actinobaculum sp. was detected by sequencing and by PathoScope but not by cultivation and in all cases it was associated with pyuria. CONCLUSIONS Using PathoScope plus 16S pyrosequencing we were able to identify unique, phenotype dependent, species level microbes. Novel findings included absent L. crispatus in the urine of females with neuropathic bladder and the presence of Actinobaculum only in subjects with neuropathic bladder.
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Affiliation(s)
- Suzanne L Groah
- MedStar National Rehabilitation Hospital, Washington, D.C.; Department of Rehabilitation Medicine, Georgetown University Hospital, Washington, D.C..
| | - Marcos Pérez-Losada
- Department of Integrative Systems Biology, Children's National Health System, Washington, D.C.; Computational Biology Institute, George Washington University, Ashburn, Virginia; CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vairão, Portugal
| | - Ljubica Caldovic
- Department of Integrative Systems Biology, Children's National Health System, Washington, D.C
| | | | - Bruce M Sprague
- Division of Urology, Children's National Health System, Washington, D.C
| | - Eduardo Castro-Nallar
- Computational Biology Institute, George Washington University, Ashburn, Virginia; Center for Bioinformatics and Integrative Biology, Facultad de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile
| | - Neel J Chandel
- MedStar National Rehabilitation Hospital, Washington, D.C
| | - Michael H Hsieh
- Division of Urology, Children's National Health System, Washington, D.C
| | - Hans G Pohl
- Division of Urology, Children's National Health System, Washington, D.C
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Mann JR, Royer JA, Turk MA, McDermott S, Holland MM, Ozturk OD, Hardin JW, Thibadeau JK. Inpatient and emergency room visits for adolescents and young adults with spina bifida living in South Carolina. PM R 2015; 7:499-511. [PMID: 25511690 PMCID: PMC4469995 DOI: 10.1016/j.pmrj.2014.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/20/2014] [Accepted: 11/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare emergency room (ER) and inpatient hospital (IP) use rates for persons with spina bifida (SB) to peers without SB, when transition from pediatric to adult health care is likely to occur; and to analyze those ER and IP rates by age, race, socioeconomic status, gender, and type of residential area. DESIGN A retrospective cohort study. SETTING Secondary data analysis in South Carolina. PARTICIPANTS We studied individuals who were between 15 and 24 years old and enrolled in the State Health Plan (SHP) or state Medicaid during the 2000-2010 study period. METHODS Individuals with SB were identified using ICD-9 billing codes (741.0, 741.9) in SHP, Medicaid, and hospital uniform billing (UB) data. ER and IP encounters were identified using UB data. Multivariable Generalized Estimating Equation (GEE) Poisson models were estimated to compare rates of ER and IP use among the SB group to the comparison group. MAIN OUTCOME MEASURES Total ER rate and IP rate, in addition to cause-specific rates for ambulatory care sensitive conditions (ACSC) and other condition categories. RESULTS We found higher rates of ER and IP use in persons with SB compared to the control group. Among individuals with SB, young adults (those 20-24 years old) had higher rates of ER use due to all ACSC (P = .023), other ACSC (P = .04), and urinary tract infections (UTI; P = .002) compared to adolescents (those 15-19 years old). CONCLUSIONS Young adulthood is associated with increased ER use overall, as well as in specific condition categories (most notably UTI) in individuals 15-24 years old with SB. This association may be indicative of changing healthcare access as people with SB move from adolescent to adult health care, and/or physiologic changes during the age range studied.
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Affiliation(s)
- Joshua R Mann
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, 3209 Colonial Drive, Columbia, SC 29203(∗).
| | - Julie A Royer
- South Carolina Revenue and Fiscal Affairs Office, Columbia, SC(†)
| | - Margaret A Turk
- Department of Physical Medicine and Rehabilitation, State University of New York Upstate Medical University, Columbia, SC(‡)
| | - Suzanne McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(§)
| | - Margaret M Holland
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(‖)
| | - Orgul D Ozturk
- Department of Economics University of South Carolina Darla Moore School of Business, Columbia, SC(¶)
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(#)
| | - Judy K Thibadeau
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA(∗∗)
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Liu JS, Dong C, Casey JT, Greiman A, Mukherjee S, Kielb SJ. Quality of life related to urinary continence in adult spina bifida patients. Cent European J Urol 2015; 68:61-7. [PMID: 25914840 PMCID: PMC4408393 DOI: 10.5173/ceju.2015.01.494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/12/2014] [Accepted: 12/21/2014] [Indexed: 01/07/2023] Open
Abstract
Introduction To analyze the correlations of bladder management technique, ambulatory status and urologic reconstruction on quality of life (QOL) as affected by urinary symptoms in adult spina bifida (SB) patients. Material and methods Sixty–six adult SB patients completed the RAND 36–Item Health Survey (mSF–36) and Incontinence Quality of Life (I–QOL). Demographic information, history of urinary reconstruction, and bladder management techniques were reviewed and analyzed with respect to survey scores. Results Mean age of patients was 32.3 (SD ±7.2) years and 44 patients (66.7%) were female. Forty–five patients (68.2%) were mainly ambulatory, 21 (31.8%) use a wheelchair and 10 (15.2%) had urologic reconstruction, while 56 (83.3%) did not. Twelve patients (18.2%) void, 42 (63.6%) perform clean intermittent catheterization (CIC), 4 (6.1%) use an indwelling catheter, 3 (4.5%) have an ileal conduit (IC) and 5 (7.6%) mainly use diapers. Mean mSF–36 General Health score was 56.5 (SD ±22.9) and mean I–QOL Sum score was 50.9 (SD ±21.7), where lower scores reflect lower QOL. mSF–36 and I–QOL scores did not significantly correlate with bladder management technique, ambulatory status or urologic reconstruction. A correlation was noted between I–QOL scales and most mSF–36 scales (all p <0.02). Conclusions In our cohort study of adult SB patients, bladder management technique and urologic reconstruction did not correlate with urinary (I–QOL) or general health (mSF–36) domains, although I–QOL and mSF–36 scores correlated closely, suggesting urinary continence is significantly related to general QOL. However, we are unable to identify a single factor that improves either urinary or general QOL.
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Affiliation(s)
- Joceline S Liu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Caroline Dong
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Jessica T Casey
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Alyssa Greiman
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Shubhra Mukherjee
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Stephanie J Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
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Ouyang L, Bolen J, Valdez R, Joseph D, Baum MA, Thibadeau J. Characteristics and survival of patients with end stage renal disease and spina bifida in the United States renal data system. J Urol 2014; 193:558-64. [PMID: 25167993 DOI: 10.1016/j.juro.2014.08.092] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE We describe the characteristics, treatments and survival of patients with spina bifida in whom end stage renal disease developed from 2004 through 2008 in the United States Renal Data System. MATERIALS AND METHODS We used ICD-9-CM code 741.* to identify individuals with spina bifida using hospital inpatient data from 1977 to 2010, and physician and facility claims from 2004 to 2008. We constructed a 5:1 comparison group of patients with end stage renal disease without spina bifida matched by age at first end stage renal disease service, gender and race/ethnicity. We assessed the risk of mortality and of renal transplantation while on dialysis using multivariate cause specific proportional hazards survival analysis. We also compared survival after the first renal transplant from the first end stage renal disease service to August 2011. RESULTS We identified 439 patients with end stage renal disease and spina bifida in whom end stage renal disease developed at an average younger age than in patients without spina bifida (41 vs 62 years, p <0.001) and in whom urological issues were the most common primary cause of end stage renal disease. Compared to patients with end stage renal disease without spina bifida those who had spina bifida showed a similar mortality hazard on dialysis and after transplantation. However, patients with end stage renal disease without spina bifida were more likely to undergo renal transplantation than patients with spina bifida (HR 1.51, 95% CI 1.13-2.03). Hospitalizations related to urinary tract infections were positively associated with the risk of death on dialysis in patients with end stage renal disease and spina bifida (HR 1.42, 95% CI 1.33-1.53). CONCLUSIONS Spina bifida was not associated with increased mortality in patients with end stage renal disease on dialysis or after renal transplantation. Proper urological and bladder management is imperative in patients with spina bifida, particularly in adults.
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Affiliation(s)
- Lijing Ouyang
- Rare Disorders and Health Outcomes Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Bethesda, Maryland.
| | - Julie Bolen
- Rare Disorders and Health Outcomes Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Bethesda, Maryland
| | - Rodolfo Valdez
- Rare Disorders and Health Outcomes Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Bethesda, Maryland
| | - David Joseph
- Department of Urology, School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Michelle A Baum
- Division of Nephrology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Judy Thibadeau
- Rare Disorders and Health Outcomes Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Bethesda, Maryland
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Malakounides G, Lee F, Murphy F, Boddy SA. Single centre experience: long term outcomes in spina bifida patients. J Pediatr Urol 2013; 9:585-9. [PMID: 23602844 DOI: 10.1016/j.jpurol.2013.02.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine our single centre experience of long term renal function and mortality rates of our cohort of spina bifida patients born since 1970. MATERIALS AND METHODS We collected a prospective database and included all patients born with spina bifida between 1970 and 2011 managed by our centre. Data we collected included the glomerular filtration rates, results of renal tract imaging, management strategies and mortalities. RESULTS Of 160 patients identified, 120 were included for analysis with a mean age of 20 years. In our cohort 48% (58/120) had normal renal function and only 1.6% (2/120) had severe renal impairment or end stage renal failure. There was a mortality rate of 4.4% and there were no deaths from renal failure. CONCLUSION Spina bifida patients have been reported to have high mortality rates and high morbidity secondary to renal failure. Historical data does not appear to reflect current advancements and we would therefore be more optimistic when counselling families about long term survival into adulthood.
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Affiliation(s)
- Georgina Malakounides
- Department of Paediatric Urology, St George's Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK.
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Adults with myelomeningocele: an interview study about life situation and bladder and bowel management. J Pediatr Urol 2013; 9:267-71. [PMID: 22521622 DOI: 10.1016/j.jpurol.2012.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/04/2012] [Indexed: 11/21/2022]
Abstract
AIM To assess life situation, and bladder and bowel management in individuals with myelomeningocele (MMC) after transferal to adult medical care. MATERIALS AND METHODS All individuals (134) with myelomeningocele from western Sweden, born before 1981, and assessed on at least two occasions by a pediatric urologist, were invited to participate in a telephone interview according to a structured protocol. Sixty-nine individuals (32 males, 37 females) with a median age of 34 years (range 27-50) agreed to participate. RESULTS Sixty-two individuals (90%) passed high school or had university education and 46 (67%) were employed. Fifty-three (77%) had their own apartment and 27 (39%) lived with a partner. Clean intermittent catheterization was used by 49 (71%), more commonly in females (p < 0.05). Pads were used by 60 (87%) individuals. Ten (14%) had urotherapy support. Of those operated on, 16 (53%) had a consultation with a urologist every 3 years; the corresponding number for the non-operated was 12 (31%). Eight individuals were treated with anticholinergic drugs. None had support for improvement of the fecal emptying regimen. CONCLUSIONS Of the participants in the study, one third had no or rare contact with a urologist, few had urotherapy support and none had support for bowel regimen.
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Vaidyanathan S, Selmi F, Soni B, Hughes P, Singh G, Pulya K, Oo T. Pyonephrosis and urosepsis in a 41-year old patient with spina bifida: Case report of a preventable death. Patient Saf Surg 2012; 6:10. [PMID: 22613462 PMCID: PMC3407709 DOI: 10.1186/1754-9493-6-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 05/21/2012] [Indexed: 11/29/2022] Open
Abstract
Background Urological complications are the major cause of ill health in patients with spina bifida. Urinary sepsis accounted for the majority of admissions in patients with spina bifida. As the patient grows older, changes occur in the adult bladder, leading to increases in storage pressure and consequent risk of deterioration of renal function, which may occur insidiously. Case presentation A 34-year-old male spinal bifida patient had been managing neuropathic bladder by penile sheath. Intravenous urography revealed normal kidneys. This patient was advised intermittent catheterisations. But self-catheterisation was not possible because of long, overhanging prepuce and marked spinal curvature. This patient developed repeated urine infections. Five years later, ultrasound examination of urinary tract revealed hydronephrotic right kidney with echogenic debris within the collecting system. There was no evidence of dilatation of the ureter near the vesicoureteric junction. The left kidney appeared normal. There was no evidence of calculus disease seen in either kidney. Indwelling urethral catheter drainage was established. Two years later, MAG-3 renogram revealed normal uptake and excretion by left kidney. The right kidney showed little functioning tissue. Following a routine change of urethral catheter this patient became unwell. Ultrasound examination revealed hydronephrotic right kidney containing thick hyper-echoic internal septations and debris in the right renal pelvis suspicious of pyonephrosis. Under both ultrasound and fluoroscopic guidance, an 8 French pig tail catheter was inserted into the right renal collecting system. 150 ml of turbid urine was aspirated immediately. This patient developed large left pleural effusion, collapse/consolidation of the left lower lobe, a large fluid collection in the abdomen extending into the pelvis and expired twenty days later because of sepsis and respiratory failure. Conclusion Although penile sheath drainage may be convenient for a spina bifida patient and the carers, hydronephrosis can occur insidiously. With recurrent urine infections, hydronephrotic kidney can become pyonephrosis, which is life-threatening. Therefore, every effort should be made to carry out intermittent catheterisations along with antimuscarinic drug therapy.
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Affiliation(s)
- Subramanian Vaidyanathan
- Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN, UK.
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de Kort L, Bower W, Swithinbank L, Marschall-Kehrel D, de Jong T, Bauer S. The management of adolescents with neurogenic urinary tract and bowel dysfunction. Neurourol Urodyn 2012; 31:1170-4. [DOI: 10.1002/nau.22206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 01/10/2012] [Indexed: 11/11/2022]
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Shin M, Besser LM, Siffel C, Kucik JE, Shaw GM, Lu C, Correa A. Prevalence of spina bifida among children and adolescents in 10 regions in the United States. Pediatrics 2010; 126:274-9. [PMID: 20624803 DOI: 10.1542/peds.2009-2084] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to estimate the number of children and adolescents, 0 to 19 years of age, living with spina bifida (SB) in the United States. METHODS A retrospective study was conducted by using population-based, birth defect surveillance data from 10 US regions, with vital status ascertainment. Birth defect surveillance data were obtained from Arkansas, Georgia (5 central counties of metropolitan Atlanta), California (11 counties), Colorado, Iowa, New York (New York City excluded), North Carolina, Oklahoma, Texas, and Utah. We estimated the numbers of children 0 to 19 years of age who were living with SB in the 10 US regions in 2002, according to age group, race/ethnicity, and gender, and examined a long-term trend in the prevalence of SB among children 0 to 11 years of age in 1991-2002. RESULTS The overall prevalence of SB among children and adolescents 0 to 19 years of age in the study regions was 3.1 cases per 10,000 in 2002. The prevalence of SB among children was lower among male and non-Hispanic black children. CONCLUSIONS The prevalence estimates of SB among children and adolescents varied according to region, race/ethnicity, and gender, which suggests possible variations in prevalence at birth and/or inequities in survival rates. Additional studies are warranted to elucidate the reasons for these variations and to derive prevalence estimates of SB among adults.
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Affiliation(s)
- Mikyong Shin
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Abstract
Spina bifida is the most common defect of the central nervous system. It is a congenital malformation of the spine with abnormal neural tube closure occurring between the third and fourth weeks of gestation, and most frequently affecting the lumbar and sacral regions. Most children with spina bifida have a normal urinary tract at birth, although renal damage and renal failure are among the most severe complications of spina bifida. Before ventricular shunting, survival rates for children with spina bifida were low, but most patients can now be expected to live into adulthood, thus prevention of urologic complications and promotion of continence have become critical. This article reviews the literature regarding urinary continence, and discusses issues across the lifespan, and implications for clinical practice and the pediatrician's role in the urologic care of children with spina bifida.
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Affiliation(s)
- Kathryn Smith
- Department of Pediatrics, University of Southern California, University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA.
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Horsnell JD, Kinder RB. A vesicocutaneous fistula secondary to bladder calculi in a patient with spina bifida. J Surg Case Rep 2010; 2010:4. [PMID: 24946330 PMCID: PMC3649133 DOI: 10.1093/jscr/2010.6.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present a rare case of a vesicocutaneous fistula secondary to two large bladder calculi in a patient with spina bifida. A 62 year old lady presented with swelling of her right thigh and a calcified mass protruding through the subcutaneous tissues of her right groin. Urine was seen to be draining from around the area and plain radiographs and a computed topography (CT) scan confirmed the presence of two bladder calculi with a vesicocutaneous fistula. Vesicolithotomy was performed and the fistula tract left to close spontaneously. Worldwide this is only the fourth case of a bladder calculus causing a vesicocutaneous fistula.
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Shin M, Besser LM, Correa A. Prevalence of spina bifida among children and adolescents in metropolitan Atlanta. ACTA ACUST UNITED AC 2008; 82:748-54. [DOI: 10.1002/bdra.20530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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