1709 LONG-TERM FOLLOW-UP FOR ADULT MYELOMENINGOCELE PATIENTS AFTER LOWER URINARY TRACT RECONSTRUCTION

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20131709 LONG-TERM FOLLOW-UP FOR ADULT MYELOMENINGOCELE PATIENTS AFTER LOWER URINARY TRACT RECONSTRUCTION Michael Vainrib, Polina Reyblat, and David A Ginsberg Michael VainribMichael Vainrib Kfar Saba, Israel More articles by this author , Polina ReyblatPolina Reyblat Los Angeles, CA More articles by this author , and David A GinsbergDavid A Ginsberg Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2955AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The majority of literature evaluating neurogenic bladder (NGB) in myelomeningocele (MMC) patients (pts) focuses on pediatric pts. Due to significant improvements in care most reach adulthood. A small but significant number of patients ultimately require lower urinary tract reconstructive surgery (LUTRS) because of NGB. Our objective was to determine if long-term follow up (F/U) is required for those who have had prior LUTRS. METHODS A retrospective review of MMC pts with NGB after LUTRS was performed. RESULTS 118 adults with NGB secondary to MMC were identified, 55/118(65%) had LUTRS with a mean age of 23.4 years (range 5-42) at LUTRS and a mean age of 37.7 years (range 20-60) at last F/U with a mean follow-up of 11 years (range 1-29 years) post-LUTRS. A majority of patients (48/55 - 87%) manage their bladder with CIC, either through their native urethra (28/48 - 58%) or continent stoma (20/48 - 42%). Prior LUTRS includes: augmentation enterocystoplasty with or without continent stoma(40/55 - 73%), construction continent stoma alone (14%), Kock Pouch (13%). In addition 6/55 (11%) pts had a concomitant outlet surgery (sling, bladder neck closure or AUS) at time of LUTRS and 9/55 (16%) subsequently had outlet surgery after their initial reconstruction. Seven pts have undergone revision of their continent stoma and 3/7 had Kock Pouch revision. The majority of pts have normal renal function based on creatinine (0.77±0.59mg/ml) and renal ultrasound (US) (41/55 pts). Kidney stones were found in 4/55 studies and 16/55(29%) pts had a stone in their bladder or “pouch”. Bladder/pouch stones were treated endoscopically in 15/16 pts with 4 pts requiring a second procedure. CONCLUSIONS Pts with MMC and NGB who underwent LUTRS still require regular F/U. Issues include the need to screen for stone disease, upper tract changes and the possibility of a need for revision surgery for continence either at the level of the stoma or outlet. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e703 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Vainrib Kfar Saba, Israel More articles by this author Polina Reyblat Los Angeles, CA More articles by this author David A Ginsberg Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...