Urologic Problems in Spina Bifida Patients Transitioning to Adult Care - 26/07/14

Doi : 10.1016/j.urology.2014.03.041

Stephen J. Summers ^a,^b,^c,^⁎ , Sean Elliott ^a,^b,^c, Sean McAdams ^a,^b,^c, Siam Oottamasathien ^a,^b,^c, William O. Brant ^a,^b,^c, Angela P. Presson ^a,^b,^c, Joseph Fleck ^a,^b,^c, Jeremy West ^a,^b,^c, Jeremy B. Myers ^a,^b,^c
^a Department of Surgery, The Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT
^b Division of Urology, Department of Surgery, the Primary Children's Medical Center, University of Utah, Salt Lake City, UT
^c Department of Urology, Children's Hospitals and Clinics of Minnesota, University of Minnesota, Minneapolis, MN

^∗Reprint requests: Stephen J. Summers, M.D., Urology Division, Department of Surgery, University of Utah, 30 North 1900 East, Room 3B420, Salt Lake City, UT 84132.

Abstract

Objective

To identify the urologic needs of adult patients with spina bifida (SB) at the time of their transition from pediatric to adult care. We hypothesized that delays in transition to adult care would be associated with higher rates of active problems.

Methods

We retrospectively reviewed patients seen at adult dedicated SB clinics at the Universities of Utah and Minnesota from April 2011 to April 2012. We reviewed bladder management, urologic problems, time from last urologic care, and necessary interventions.

Results

We identified 65 patients from these clinics with SB. The mean age was 30.6 years (standard deviation, 11.3). The median time since last urologic evaluation at Utah and Minnesota was 17 months and 12 months, respectively (range 1 month-10 years). Fifty-five patients (85%) reported a urologic problem at the time of their visit. Urinary incontinence was most common in 34 (52%), followed by recurrent urinary tract infection in 22 (34%), catheterization troubles in 8 (12%), and calculi in 6 (9%). Sixty-three patients (97%) required some sort of intervention. These were diagnostic (cystoscopy, ultrasonography, computed tomography scan, urodynamics) in 50 patients (77%), surgical (urinary diversion, onabotulinum toxin A injection, stone surgery, and so forth) in 22 (34%), and medical (antimicrobial prophylaxis, bladder irrigations, anticholinergics, self-catheterization) in 16 (25%). There was no association between longer transition times and higher rates of active problems.

Conclusion

On presentation to adult SB clinics, patients had many active urologic problems and operative management was often needed; however, there was no association between longer transition times and higher rates of active problems.

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	*Financial Disclosure:* The authors declare that they have no relevant financial interests.
	*Funding Support:* This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000105 (formerly UL1RR025764).