Comparison of neurogenic lower urinary tract dysfunctions in open vs. closed spinal dysraphism: Results observed in a prospective cohort of 395 patients

Abstract

Spinal dysraphism is the first congenital cause of neurogenic bladder. Open spinal dysraphism (mainly myelomeningocele) being diagnosed in the neonatal period, neurogenic lower urinary tract dysfunctions (NULTD) are well-known as they have been described in many series. Conversely, closed spinal dysraphisms are often diagnosed later and little data regarding NULTD exist. The aim of this study was to compare the NULTD in patients with closed dysraphism (CD) to those in patients with open dysraphism (OD). A prospective study was conducted between 2007 and 2016 including all spina bifida patients seen in a multidisciplinary national referral center. At the first visit, lower urinary tract function was assessed as follow: history of past urological surgery, type of spinal dysraphism, Abbreviated Injury Scale, method of bladder emptying, Urinary Symptom Profil (USP) and Qualiveen scores and urodynamic parameters. In total, 395 patients were included: 274 with OD (69.4%) and 121 with CD (30.6%). Patients in the CD group were older (35.9 vs. 29.5 years, P < 0.0001), and had lower BMI (23.8 vs. 28 years, P = 0.0002). The method of bladder emptying was spontaneous voiding, clean intermittent catheterization and transileal cutaneous ureterostomy in 47.1% vs. 29.3%; 47.1% vs. 59.4% and 5.7% vs. 11.2% of CD and OD patients respectively ( P = 0.01). The prevalence of urinary incontinence did not differ significantly between the two groups (44.7% vs. 53.5%), as well as the mean Qualiveen score (76.6 vs. 81.7). The main medical concern was NLUTD in 26% of patients with CD and in 27.8% of patients with OD ( P = 0.73). Surgery (augmentation cystoplasty, artificial urinary sphincter, continent cystostomy) was more common in patients with OD ( P < 0.01). NLUTD were as frequent and troublesome in patients with open vs. closed spinal dysraphism. However the need for a surgical treatment was more common in patients with OD.