Most children with spina bifida (SB) now survive into adulthood, but most have neuropathic bladder with potential complications of incontinence, infection, renal damage, and diminished quality of life. We sought to 1) describe contemporary bladder management and continence outcomes of adults with SB; 2) describe differences from younger patients; and 3) assess for association with socio-economic factors.
We analyzed data on bladder management and outcomes from The National Spina Bifida Patient Registry in adults with SB. A strict definition of continence was utilized. Results were compared to young children (5-11 years) and adolescents (12-19 years). Statistical analysis compared cohorts by gender, ethnicity, SB type, lesion level, insurance status, educational attainment, employment status, and continence.
5250 SB patients were included; 1372 (26.1%) were adults. 45.8% of adults did not take medication, but 76.8% performed clean intermittent catheterization. Continence was lower in adults with myelomeningocele (MMC) (45.8%) versus those with non-MMC SB (63.1%) (p<0.0001). Continence rates were higher in older age cohorts for MMC patients (p<0.0001) but not non-MMC patients (p=0.1192). Bladder management and histories of urologic surgery varied among age groups. On univartiate analysis with SB-related or socio-economic variables, continence was significantly associated with educational level, but on multivariable logistic regression analysis, bladder continence was significantly associated with employment status only.
Bladder management techniques differ between adults and younger patients with SB. Bladder continence outcomes were better in adults with nearly one-half reporting continence. Continence was significantly associated with employment status in adults 25 years or older.
The Journal of urology. 2018 Mar 24 [Epub ahead of print]
John S Wiener, Kristina D Suson, Jonathan Castillo, Jonathan C Routh, Stacy Tanaka, Tiebin Liu, Elisabeth Ward, Judy Thibadeau, David Joseph, National Spina Bifida Patient Registry
Division of Urologic Surgery, Duke University Medical Center, Durham NC. Electronic address: ., Department of Urology, Children's Hospital of Michigan, Detroit MI., Department of Pediatrics, Baylor College of Medicine, Houston TX., Division of Urologic Surgery, Duke University Medical Center, Durham NC., Department of Urology, Vanderbilt University, Nashville TN., Centers for Disease Control and Prevention, Atlanta GA., Centers for Disease Control and Prevention, Atlanta GA; Carter Consulting, Inc., Atlanta GA., Department of Urology, University of Alabama at Birmingham, Birmingham AL.