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Early Vs. Expectant Management of Spina Bifida Patients—Are We All Talking About a Risk Stratified Approach?

  • Pediatric Urology (D Weiss, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Advancements in the care of patients affected by myelomeningocele have flourished in recent years especially with respect to renal preservation and continence. Involvement of urologists both prenatally and early in life has driven many developments in preventative care and early intervention. As of yet, however, the ideal management algorithm that offers these patients the least invasive diagnostic testing and interventions while still preserving renal and bladder function remains ill defined.

Recent Findings

In a shift from prior years where the use of surgical intervention and intermittent catheterization were more liberally employed, some providers have more recently advocated for monitoring patients in a more conservative manner with a variety of diagnostic tests until radiographic or clinical changes are discovered. The criteria used to define the need for catheterization and the timing to initiate CIC or more invasive interventions is disparate across pediatric urology and there is published data to support several approaches.

Summary

This review presents some of these criteria for use of CIC and some newer evidence to support different approaches along with supporting the trend toward individualized medicine and use of risk stratification in developing clinical treatment algorithms.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Urology, Division of Pediatric Urology, Children’s Health System Texas, University of Texas Southwestern, Dallas, TX, USA

    Angelena B. Edwards & Micah Jacobs

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  1. Angelena B. Edwards
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  2. Micah Jacobs
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Correspondence to Angelena B. Edwards.

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Angelena B. Edwards and Micah Jacobs each declare no potential conflicts of interest.

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Edwards, A.B., Jacobs, M. Early Vs. Expectant Management of Spina Bifida Patients—Are We All Talking About a Risk Stratified Approach?. Curr Urol Rep 20, 76 (2019). https://doi.org/10.1007/s11934-019-0943-z

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