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Risk of prolapse and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor using clean intermittent catheterization versus Valsalva voiding
Author(s) -
El Akri Mehdi,
Brochard Charlène,
Hascoet Juliette,
Jezequel Magali,
Alimi Quentin,
Khene Zineeddine,
Richard Claire,
Bonan Isabelle,
Kerdraon Jacques,
Gamé Xavier,
Manunta Andrea,
Siproudhis Laurent,
Peyronnet Benoit
Publication year - 2019
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.23844
Subject(s) - medicine , spina bifida , vesicoureteral reflux , valsalva maneuver , urinary system , clean intermittent catheterization , urinary incontinence , urology , surgery , bladder exstrophy , urinary retention , urinary bladder , reflux , blood pressure , disease
Aims To assess the relative risks of pelvic organ prolapse (POP) and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor voiding with Valsalva versus those using clean‐intermittent catheterization (CIC). Methods We conducted a retrospective analysis including all spina bifida patients with neurogenic acontractile detrusor with a minimum follow‐up of 12 months. Patients were then divided in two groups according to their bladder management: voiding with Valsalva versus CIC. The primary endpoint was any de novo or worsened rectal and/or pelvic organ prolapse (POP) diagnosed during follow‐up. The secondary outcome was urinary complications defined as febrile urinary tract infections (UTI) and/or urolithiasis and/or renal failure. Results Fifty‐five patients (50.9% were males) met the inclusion/exclusion criteria: 28 voiding with Valsalva and 27 performing CIC. At baseline, the rates of vaginal prolapse (44.4% vs 50%; P = 0.99), and rectal prolapse/intussusception (25.9% vs 21.4%; P = 0.76) were similar in both groups. After a median follow‐up of 80.6 and 65.6 months, respectively ( P = 0.29), the rate of de novo or worsened rectal prolapse/intussusception was higher in the Valsalva voiding group than in the CIC group (32.1% vs 3.7%; P = 0.01). De novo or worsened vaginal prolapses were also more common in the Valsalva voiding group, but it did not reach statistical significance (33.3% vs 11.1%; P = 0.29). Conclusions Valsalva voiding might be harmful in adult spina bifida patients with neurogenic acontractile detrusor as it may increase the risk of rectal prolapse/intussusception. Overall, the prevalence of POP and rectal prolapse was high in both groups.