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Risk factors for upper urinary tract deterioration in adult patients with spina bifida

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Abstract

Purpose

Neurogenic bladder associated with spina bifida disease remains a major cause for mortality or morbidity due to kidney damages. However, we currently do not know which urodynamic findings are associated with an higher risk of upper tract damages in spina bifida patients. The objective of the present study was to evaluate urodynamic findings associated with functional kidney failure and/or with morphological kidney damages.

Methods

A large single-center restrospective study was conducted in our national referral center for spina bifida patients using our patients’ files. All urodynamics curves were assessed by the same examinator. Functional and/or morphological evaluation of the upper urinary tract were done at the same moment as the urodynamic exam (between 1 week before and 1 month after). Kidney function was assessed using creatinine serum levels or 24 h urinary creatinine levels (creatinine clearance) for walking patients, or with the 24 h urinary creatinine level for wheelchair‐users.

Results

We included 262 spina bifida patients in this study. Fifty-five patients had a poor bladder compliance (21.4%) and 88 of them had detrusor overactivity (33.6%). Twenty patients had a stage 2 kidney failure (eGFR < 60 ml/min) and 81 patients out of 254 (30.9%) had an abnormal morphological examination. There were three urodynamic findings significantly associated with UUTD: bladder compliance (OR = 0.18; p = 0.007), Pdetmax (OR = 14.7; p = 0.003) and detrusor overactivity (OR = 1.84; p = 0.03).

Conclusion

In this large series of spina bifida patients, maximum detrusor pressure and bladder compliance are the main urodynamic findings determinants of UUTD risk.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, Camille Haudebert.

Abbreviations

BMI:

Body Mass Index

AUC:

Area under the curve

CC:

Cystometric capacity

CIC:

Clean Intermittent Catheterization

CNIL:

Comité National Informatique et Libertés

CT:

Computed Tomography

DLPP:

Detrusor leak point pressure

MRI:

Magnetic Resonance Imaging

MUCP:

Maximum urethral closure pressure

NLUTD:

Neurological Lower Urinary Tract Dysfunction

Pdetmax:

Maximum detrusor pressure

PVR:

Post-void residual

SB:

Spina bifida

UUTD:

Upper Urinary Trast Deterioration

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France

    Camille Haudebert, Juliette Hascoet, Andréa Manunta & Benoit Peyronnet

  2. Department of Physical Medicine and Rehabilitation, Department of Urology, Rennes, France

    Emmanuelle Samson, Caroline Voiry & Claire Richard

  3. Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France

    Emmanuelle Samson, Magali Jezequel, Charlène Brochard, Claire Richard, Jacques Kerdraon, Laurent Siproudhis, Andréa Manunta & Benoit Peyronnet

  4. Department of Gastro-Enterology, University of Rennes, Rennes, France

    Charlène Brochard & Laurent Siproudhis

Authors
  1. Camille Haudebert
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  2. Juliette Hascoet
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  3. Emmanuelle Samson
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  4. Magali Jezequel
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  5. Caroline Voiry
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  6. Charlène Brochard
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  7. Claire Richard
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  8. Jacques Kerdraon
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  9. Laurent Siproudhis
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  10. Andréa Manunta
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  11. Benoit Peyronnet
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Contributions

CH: project development, data collection, manuscript writing; JH: manuscript writing; ES: data collection; MJ: data collection; CV: data collection; CB: manuscript writing; CR: manuscript writing; JK: project development; LS: manuscript writing; AM: project development, Manuscript writing; BP: project development, data analysis, manuscript writing.

Corresponding author

Correspondence to Camille Haudebert.

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Conflict of interest

Authors have no competing interests for this work.

Research involving human participants

This study was conducted following the principles of the Helsinki declaration. It was approved by the CNIL (Comité National Informatique et Liberté, CNIL 2227168). All the procedures being performed were part of the routine care.

Consent to participate

Verbal informed consent was obtained from all individual participants included in the study.

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Haudebert, C., Hascoet, J., Samson, E. et al. Risk factors for upper urinary tract deterioration in adult patients with spina bifida. World J Urol 41, 1187–1192 (2023). https://doi.org/10.1007/s00345-023-04314-1

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  • DOI: https://doi.org/10.1007/s00345-023-04314-1

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