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Urological follow-up of adult spina bifida patients
Imran Ahmad1, Paraskeve Granitsiotis
1Department of Urology, Southern General Hospital, Glasgow, Scotland, United Kingdom. imranahmad@doctors.net.uk
Insights
Adults with spina bifida require lifelong urological management to preserve kidney function and prevent adult mortality. Early and continuous treatment is crucial for long-term renal health in spina bifida patients.
Area of Science:
- Urology
- Nephrology
- Pediatric Surgery
Background:
- Spina bifida management has shifted from pediatric to adult care due to improved survival rates.
- Adult urological issues in spina bifida are increasingly recognized as a significant health concern.
Purpose of the Study:
- To review current literature on adult spina bifida urological management.
- To develop evidence-based guidelines for managing adult spina bifida patients.
Main Methods:
- Comprehensive literature review focusing on adult spina bifida urological management.
- In-depth analysis of articles concerning long-term care and adult outcomes.
Main Results:
- Deterioration of renal function in adulthood is a primary cause of mortality in spina bifida patients.
- Increased bladder storage pressures contribute to renal decline.
- Management strategies must focus on preserving renal function and urinary continence throughout life.
Conclusions:
- Most individuals with spina bifida can maintain their own kidney function throughout life.
- This necessitates early-onset urological treatment initiated in childhood and continued into adulthood.
Aims:
The vast majority of the current urological literature understandably has concentrated on the management of children with spina bifida, because in the past the majority did not survive into adulthood. With improvements in the understanding and multidisciplinary care of spina bifida patients it has become a disease of adults. Our aim was to evaluate the current literature to attempt to formulate evidence based guidelines for the management of this difficult group of patients.
Methods:
We reviewed the literature on adult urological management of spina bifida, all relevant articles which concentrated on adults and long-term management were studied in full.
Results:
Renal function may begin/continue to deteriorate into adulthood, becoming the leading cause of adult death. This is thought to occur because of changes in the adult bladder, with increases in storage pressure. Medical and surgical management should aim to preserve renal function as well as the maintenance of continence in the face of the growing and changing urinary tract. Follow-up should be regular and in the context of a specialist multidisciplinary clinic. Despite being unvalidated in the follow-up of adult spina bifida patient's annual serum creatinine, ultrasound and urodynamics are currently the best tools available.
Conclusions:
There is no reason why the majority of spina bifida sufferers cannot use their own kidneys for the rest of their lives. This however relies on urological treatment being instigated soon after birth and continuing into adulthood.
