PD10-08 THE NATURAL HISTORY OF NEUROGENIC BLADDER IN ADULTS WITH SEVERE CEREBRAL PALSY

Abstract

INTRODUCTION AND OBJECTIVES: Patients with neurological conditions often suffer from severe debilitating lower urinary and bowel dysfunction in addition to their physical disabilities. However, only the bladder has received the attention of medical providers with neurogenic bowel being poorly understood and characterized. The primary aim in this study was to determine the level of severity and impact on quality of life of bowel dysfunction in a population with neurogenic bladder using validated surveys and to determine those patient variables that correlate with worse bowel symptoms. Our second aim was to determine if the severity of bowel dysfunction correlates with the severity of bladder dysfunction. METHODS: This is a cross-sectional analysis of a prospective institutional Neurogenic Bladder Database from 2010e2013. RESULTS: Among the 175 patients 60.6% had traumatic SCI and 18.3% MS. Fecal Incontinence Severity Index (FISI) scores were a median of 18.0 1.39 (moderate). Neurogenic Bowel Dysfunction (NBD) score, which is specific to patients with neurological disease, were a median of 11.0 0.63 (moderate). NBD Scores were worse in those patients with SCI and myelomeningocele compared to other diseases (P1⁄40.020), in younger patients (p1⁄40.020) and in the SCI group those with higher levels of injury (p1⁄40.0046). Based on the Bristol stool scale 65% of patient had abnormal stool consistency, mostly constipation. None of the FISI, Bristol or NBD scores correlated significantly with SF12 quality of life measures. None of the urodynamic findings correlated with any of the bowel symptom scores. However, both of the bladder symptom scores Michigan Incontinence Symptom Index (MISI)(p1⁄40.05) and the AUA-SI (p1⁄40.03) correlated with FISI severity and the NBD score correlated with the M-ISI (~ n1⁄40.29, p1⁄40.02). Those patients with abnormal stool consistency on the Bristol reported more urgency and stress incontinence on M-ISI. CONCLUSIONS: Bowel dysfunction is very common among patients with neurogenic bladder. Those patients with worse bladder symptoms also suffered from worse bowel dysfunction although the severity of bowel dysfunction did not correlate with overall quality of life or urodynamic measures.