Urologic management of spina bifida

Abstract

The urologist plays an important role in the multidisciplinary team of physicians who provide care for patients with spina bifida. We review common strategies for managing the urinary tract in these patients. The primary objective in all phases of life is protecting kidney function by minimizing bladder hostility and establishing a good capacity, low-pressure urinary reservoir. Ensuring adequate bladder and bowel continence is also paramount for enhancing self-esteem and independence. Medical therapy incorporating clean intermittent catheterization and antimuscarinic medication is the cornerstone of neurogenic bladder management and often the only intervention required to achieve the above goals. Others may require formal lower urinary tract reconstruction to prevent urinary tract deterioration. As will be shown, current management, while effective, is not supported by strong evidence-based protocols; and the impact of any intervention upon quality of life, while subjectively seen as positive, does not have objective validation. These limitations are recognized and currently the subject of urologic investigation.

Cotransplantation with specific populations of spina bifida bone marrow stem/progenitor cells enhances urinary bladder regeneration

“…SB patients affected by myelomeningocele nonexclusively suffer from bowel and urinary bladder abnormalities as a consequence of developmental error (3). The resulting neurogenic bladder predisposes a poor clinical outcome in which bladder function is below acceptable levels, leading to renal insufficiencies and ultimately to renal failure (4).…”

Patients With Spina Bifida and Their Caregivers’ Feelings About Intermittent Bladder Catheterization in Brazil and Germany: A Correlational Study

“…Currently, following surgical repair in the first 2 years of life, control of hydrocephalus and proper management of the neurogenic bladder, an increasing number of children with SB have reached adulthood (Bowman, 2009). The major complication that individuals with SB face is related to the management of neurogenic bladder, where the inability to store or remove urine at low pressures (<40 cmH 2 O) (caused by thickening of the walls of the bladder and excessive contractions or bladder-sphincter dyssynergy) may cause deterioration in the upper urinary tract and consequent renal injury (Clayton, Brock, & Joseph, 2010).…”

Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

“…Moreover, funds for research are likely more available for more prevalent diseases and many hurdles are inherent in multi-centered, randomized clinical trials for pediatric diseases. 4 This study was designed to define the number and type of surgeries performed in patients with MMC. Considering that the functional motor level of a patient with spina bifida (SB) is the primary determinant of neurological alterations, major orthopedic deformities, ambulatory status, treatment, outcome, and ultimate prognosis, 5 we intended to define a pattern of surgeries according to the neurological level of involvement.…”