Paucity of evidence for urinary tract outcomes in closed spinal dysraphism: a systematic review. (11th October 2013)

• Record Type: Journal Article
• Authors: Veenboer, Paul W.; Bosch, J.L.H. Ruud; van, Floris W.A.; de, Laetitia M.O.
• Is Part Of: BJU international. Volume 112:Number 7(2013:Oct.)
• Page Start: 1009
• Page End: 1017
• Publication Date: 2013-10-11
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12289
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12289-sec-1001" sec-type="section"> <title>Objectives</title> <p> <list id="bju12289-list-0001" list-type="bullet"> <list-item> <p>To describe the long‐term upper (UUT) and lower urinary tract (LUT) outcomes in patients with closed spinal dysraphism (CSD).</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> <sec id="bju12289-sec-5001" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12289-list-5001" list-type="bullet"> <list-item> <p>A systematic review was performed following the standards of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. An extensive search was made of PubMed and EMBASE.</p> </list-item> <list-item> <p>Included were papers on adults with any form of primary CSD that described bladder and/or kidney function. Only English and Dutch language papers were included. Excluded were papers on patients aged <18 years and patients with secondary tethered cord following childhood OSD repair. International Continence Society terminology was used to describe LUT outcomes.</p> </list-item> </list> </p> </sec> <sec id="bju12289-sec-5002" sec-type="section"> <title>Results</title> <p> <list id="bju12289-list-5002" list-type="bullet"> <list-item> <p>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.</p> </list-item> <list-item> <p>Urological complaints were present in 54/79 (68.4%) patients.</p> </list-item> <list-item> <p>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.</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> <sec id="bju12289-sec-5003" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12289-list-5003" list-type="bullet"> <list-item> <p>Few data are available on long‐term urological outcomes in adult patients with CSD.</p> </list-item> <list-item> <p>More extensive research on follow‐up, including the functional status of the UUT, is recommended.</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> </abstract>