MP18-16 DECISION REGRET IN ADULTS WITH SPINA BIFIDA FOLLOWING CHILDHOOD MACE CREATION

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP18-16 DECISION REGRET IN ADULTS WITH SPINA BIFIDA FOLLOWING CHILDHOOD MACE CREATION Ashley W. Johnston, Konrad M. Szymanski, Rosalia Misseri, and Joshua D. Roth Ashley W. JohnstonAshley W. Johnston More articles by this author , Konrad M. SzymanskiKonrad M. Szymanski More articles by this author , Rosalia MisseriRosalia Misseri More articles by this author , and Joshua D. RothJoshua D. Roth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our objective was to assess decision regret (DR) among adults with spina bifida (SB) regarding Malone antegrade continence enema channel (MACE) creation in childhood. METHODS: In our SB clinic, we surveyed consecutive adult patients (≥18 years old [y]) who underwent MACE creation at <18y (6/2018-1/2020). Utilizing the Decision Regret Scale, DR was categorized as: none (0), mild (1-25), moderate (26-50), strong (51-75), very strong (>75). We analyzed whether bowel management habits (catheterizations, flushing toilet time, and stool evacuation), bowel symptoms (fecal incontinence and leakage per MACE), or symptom bother impacted DR. Patient factors were assessed on exploratory analysis. Non-parametric tests and logistic regression were used. RESULTS: Of the 71 patients (52% male, 90% White) who met inclusion criteria, the median ages at survey participation was 24y and MACE creation occurred at 7y. Eighty-six percent had a ventriculoperitoneal shunt and 45% used a wheelchair. Median DR score was 0 and 58% without any DR. Of those with some DR, the majority were mild (28%) and moderate (11%) with few strong (1%) or very strong (1%).The majority of patients, 73%, were independently flushing a median 7 times/week and spending a median 1 hour on the toilet. DR was significantly associated with both time on the toilet >1 hour (p=0.02, OR 3.7, 95%CI [1.3-10.8]) and bother waiting for stool evacuation (p=0.02, OR 3.2, 95%CI [1.2-8.5]) (Table 1). Difficulty catheterizing was also associated with DR (p=0.02, OR=3.3, 95%CI [1.2-9.5]). On multivariate logistic regression, only catheterization difficulty was significantly associated with DR (p=0.05, OR 3.3, 95%CI [0.99-10.9]). Forty-six percent of patients experienced some degree of fecal incontinence and the majority (88%) were bothered by it. Neither incontinence nor MACE leakage increased DR (p≥0.22). On exploratory analysis, patient demographic factors were not associated with increased DR (p>0.3). CONCLUSIONS: The majority of adults with SB do not regret undergoing MACE creation as children. Those with DR have mild to moderate levels. Time on the toilet exceeding an hour, self-reported bother related to the time needed for flushing, and catheterization issues contribute to post-MACE DR. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e229 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashley W. Johnston More articles by this author Konrad M. Szymanski More articles by this author Rosalia Misseri More articles by this author Joshua D. Roth More articles by this author Expand All Advertisement PDF downloadLoading ...