Upper and Lower Urinary Tract Outcomes in Adult Myelomeningocele Patients: A Systematic Review
OBJECTIVE To evaluate a population of adult spina bifida patients performing clean intermittent catheterization (CIC) and determine the indications for urologic consultation and intervention. METHODS We evaluated 52 adults (ages 18-37 years) with a history of lumbar myelomeningocele, all of whom performed CIC and were dry between catheterizations. We excluded 12 patients with conditions potentially predisposing to renal insufficiency (staghorn calculus, n = 3; multiple admissions for pyelonephritis, n = 5; history of vesicoureteral reflux, n = 2, and renal scarring on ultrasound, n = 2), leaving 40 patients evaluable. Each patient kept a catheterization diary for 2 weeks from which an average catheterized volume was recorded. RESULTS In patients with normal ultrasound and normal serum creatinine (<1.5 mg/dl), there were no individuals (0/20) whose average catheterized volume corresponded to a bladder pressure of >40 cm H(2)O on cystometry. However, in the patients with hydronephrosis and/or elevated creatinine, 30% (6/20) had average catheterized volumes corresponding to a bladder pressure of >40 cm H(2)O, and are therefore theoretically at risk for upper tract deterioration. CONCLUSION Many spina bifida patients receive urologic care only as children, and those without urinary calculi or urinary incontinence are assumed to be urologically stable. However, certain patients have urodynamic parameters which put them at risk for renal deterioration even if they appear to be problem-free. We recommend a yearly renal ultrasound and serum creatinine determination in all adult spina bifida patients with immediate urologic consultation and urodynamics if either is abnormal.