Spina Bifida

Renal and urinary issues

  • Historically, renal failure was the most common cause of mortality for these patients, making urologic monitoring throughout life especially important.
  • Upper tract issues are often attributable at least in part to neurogenic pathology of the lower urinary tract.
  • Detrusor-sphincter dyssynergia can contribute to chronically elevated intravesical pressures, resulting in remodeling of the bladder wall.
  • Changes to the bladder dynamics can also occur as a result of chronic infections, inflammation, or lower urinary tract stones.
  • These changes may cause worsening lower tract compliance, leading to transmission of elevated pressures to the upper tracts or worsening urinary incontinence.

Reasons for follow-up

Adolescence is a critical time for urologic monitoring in many of these patients because multiple changes occur in the bladder, including an increase in detrusor leak point pressure, bladder capacity, and maximum detrusor pressure.

These changes can lead to hydronephrosis and worsening renal function if left unchecked

Many patients with poor bladder compliance may need aggressive management with catheterization; antimuscarinic agents; intradetrusor botulinum toxin injections; or even surgical interventions, such as augmentation cystoplasty.

For those patients who previously underwent bladder augmentation, ongoing care and surveillance is also essential.

These individuals are at risk of catheterizable channel stenosis, bladder stones, augment perforation, metabolic abnormalities, vitamin B12 deficiency, and bone demineralization.

Transitional urology
11 / 22
11 / 22