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Paucity of evidence for urinary tract outcomes in closed spinal dysraphism: a systematic review
Author(s) -
Veenboer Paul W.,
Bosch J.L.H. Ruud,
Asbeck Floris W.A.,
Kort Laetitia M.O.
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12289
Subject(s) - medicine , spinal dysraphism , urinary system , asymptomatic , upper urinary tract , renal function , surgery , pediatrics , urology , spina bifida
Objectives To describe the long‐term upper ( UUT ) and lower urinary tract ( LUT ) outcomes in patients with closed spinal dysraphism ( CSD ). CSD differs from open spinal dysraphism ( OSD ) by its long asymptomatic course and consequent later diagnosis. The outcome of UUT and LUT function in adults with CSD is relatively unknown.Patients and Methods A systematic review was performed following the standards of the P referred R eporting I tems for S ystematic R eviews and M eta‐ A nalyses ( PRISMA ) guidelines. An extensive search was made of P ub M ed and EMBASE . Included were papers on adults with any form of primary CSD that described bladder and/or kidney function. Only E nglish and D utch language papers were included. Excluded were papers on patients aged <18 years and patients with secondary tethered cord following childhood OSD repair. International C ontinence S ociety terminology was used to describe LUT outcomes.Results Eventually, only seven studies (90 patients) were included and none of these described renal outcomes. Five of the seven papers were on outcomes after untethering surgery during adulthood. Urological complaints were present in 54/79 (68.4%) patients. Urodynamic studies (48 patients available) revealed detrusor underactivity in 46.5% of the evaluated cases, detrusor overactivity in 32.6% and normal findings in 16.3% of the studied patients. Symptomatic improvement after surgery for tethered cord occurred in 33.3–90.0%, depending on the subgroup studied. Urodynamic improvement rates ranged from 11.1% to 54.5% (but based on three studies with only 24 patients). Success of surgery depended on the time between onset of symptoms and operation, and (sometimes) type of lesion.Conclusions Few data are available on long‐term urological outcomes in adult patients with CSD . More extensive research on follow‐up, including the functional status of the UUT , is recommended. Based upon the little evidence available, we think life‐long follow‐up (from birth into adulthood) of those with CSD and neurogenic bladder is advisable.