Urinary considerations for adult patients with spinal dysraphism

• Published in: Nature reviews. Urology Vol. 12; no. 6; pp. 331 - 339
• Main Authors: Veenboer, Paul W., de Kort, Laetitia M. O., Chrzan, Rafal J., de Jong, Tom P. V. M.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-06-2015; Nature Publishing Group
• Subjects: 692/4022/1585/104/1586; 692/4025/2768/587; 692/617/375/361; 692/699/1585/273; 692/699/2768/515; Adult; Adults; Bladder; Complications and side effects; Forecasts and trends; Humans; Lower Urinary Tract Symptoms - physiopathology; Medical research; Medicine & Public Health; Medicine, Experimental; Myelodysplastic syndromes; Patients; Pediatrics; Puberty; Quality of Life; review-article; Spina bifida; Spina Bifida Cystica - complications; Spina Bifida Cystica - physiopathology; Spinal cord; Spinal diseases; Ultrasonic imaging; Urinary Bladder Neoplasms - etiology; Urinary Bladder, Neurogenic - etiology; Urinary Calculi - etiology; Urinary incontinence; Urinary Tract Infections - etiology; Urodynamics; Urogenital system; Urologic diseases; Urology; United States > US; Netherlands
• ISSN: 1759-4812; 1759-4820
• DOI: 10.1038/nrurol.2015.99

Key Points
An increasing number of patients with spinal dysraphism reach adulthood, owing to improved care during childhood
A completely new group of older patients with spinal dysraphism is, therefore, emerging and requires specialized urological care
Well-known issues in patients with spinal dysraphism include neurogenic bladder and pelvic floor dysfunction, which often result in urinary incontinence
Attention should also be paid to patients' sexual function, quality of life and the long-term effects of treatments received during childhood
Lifelong follow-up monitoring of these patients does seem to be necessary as treatment and management is often complex
Patients with spinal dysraphism can have a large variety of different urological manifestations, thus, effective clinical management of these patients can involve a range of different approaches. Here, authors describe the management of the full range of urological manifestations observed in patients with spinal dysraphism and the future challenges posed by the changing demographics of this patient population.
The incidence of newborns with spinal dysraphism is diminishing worldwide, although survival of individuals with this condition into adulthood continues to improve. The number of adults with spinal dysraphism will, therefore, increase in the coming years, which will pose new challenges in patient management. Urological manifestations of spinal dysraphism can include increased risks of urinary incontinence, urinary tract infection, urinary calculi, sexual dysfunction, end-stage renal disease and iatrogenic metabolic disturbances; however, the severity and incidence of these symptoms varies substantially between patients. Owing to the presence of multiple comorbidities, treatment and follow-up protocols often have to be adapted to best suit the needs of specific patients. Authors describe bladder and kidney function and long-term complications of treatments initiated in childhood, as well as the potential for improvements in quality of life through better follow-up schedules and future developments.