Paediatric follow-up and care for urological dysfunction in cases of spina bifida: A monocentric retrospective French cohort study of 40 cases between 2004-2022.

INTRODUCTION

Congenital spina bifida is the main cause of neurological bladder-sphincter problems in paediatric patients. All their life they need an urological care and a close follow-up. The latest French data indicates an increase in SB children born alive. The medical termination of pregnancy rate for SB reached a peak in 2005 before decreasing. In 2022 the European Association of Urology updated its management of neurogenic bladder recommendations for children. These recommendations suggest proactive care rather than the historical expectant management.

OBJECTIVE

The objective of this study was to assess the management of urological conditions in paediatric patients with congenital SB in university hospital.

MATERIAL AND METHODS

We carried out searches using the search terms "dysraphisme médullaire" (spinal dysraphism) and "spina bifida" in the medical file database. This search included multidisciplinary neurogenic bladder consultations for children, paediatric neurosurgery consultations for spinal dysraphism, and cystomanometry reports.

RESULTS

A total of 40 children with confirmed spina bifida were included. An antenatal diagnosis was made for 42.9% of patients. All the patients underwent surgery postnatally. As at the last urological consultation, social urinary continence was estimated at 77%, with 48% of patients always dry. Of the patients who were followed up by a paediatric urologist, 42.8% were assessed in a multidisciplinary consultation. They seemed have better urinary continence, with 66.7% always dry against 40% of those who did not have a multidisciplinary consultation. The incidence of clean intermittent catheterisation (CIC) was 73%, but this treatment was often put in place later than recommended. Among the patients, 61.7% were taking anticholinergics or related medications. Twenty-six percent underwent surgery for complications linked to detrusor overactivity, compliance problems or VUR. The incidence of detrusor overactivity (DO) was 38.1% at the first assessment compared to 30.7% at the last. The observed functional bladder capacity/expected functional bladder capacity ratio measured during UDS improved in 66.6% of cases. An improvement in compliance was noted in 70% of the patients. According to the scoring for overall urodynamic improvement, 38.5% of UDS were fully improved.

DISCUSSION

Urological care management from 2022 EAU recommendations is a proactive approach. Actually almost half of health professional follow their own urological management in SB. Developing clinical pathway and multidisciplinary consultation may improve urological health in SB.

CONCLUSION

The results highlight the need to reinforce an early start for a clinical and care pathway, in accordance with European recommendations. Mainly due to patients not returning for postnatal follow-up and delayed or unsystematic implementation of urodynamic evaluation. However, the results show 48% total continence; an incidence of complications, which was not increased after follow-up; and a substantial number of patients treated with CIC and ATC/rel. Close multidisciplinary cooperation would appear to be essential to optimise care for these children.