Role of urologic evaluation in the adult spina bifida patient

Objective: To evaluate a population of adult spina bifida patients performi ng clean intermittent catheterization (CIC) and determine the indications f or urologic consultation and intervention. Methods: We evaluated 52 adults (ages 18-37 years) with a history of lumbar myelomeningocele, all of whom p erformed 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), lea ving 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), t here were no individuals (0/20) whose average catheterized volume correspon ded to a bladder pressure of >40 cm H2O on cystometry. However, in the pati ents with hydronephrosis and/or elevated creatinine, 30% (6/20) had average catheterized volumes corresponding to a bladder pressure of >40 cm H2O, an d are therefore theoretically at risk for upper tract deterioration. Conclu sion: Many spina bifida patients receive urologic care only as children, an d those without urinary calculi or urinary incontinence are assumed to be u rologically stable. However, certain patients have urodynamic parameters wh ich put them at risk for renal deterioration even if they appear to be prob lem-free. We recommend a yearly renal ultrasound and serum creatinine deter mination in all adult spina bifida patients with immediate urologic consult ation and urodynamics if either is abnormal. Copyright (C) 1999 S. Karger A G, Basel.