Management of the neuropathic bladder secondary to Spina Bifida (SP) remains a challenging endeavor. Renal preservation and continence are treatment goals which are based upon urodynamic monitoring. We have minimal prognostic data beyond McGuires initial discovery that maintaining pDet < 40 mm H2o is associated with less hydronephrosis. Therefore, we wish to retrospectively review serially tabulated urodynamics in young adults to determine variables associated with urodynamic deterioration and major surgical intervention. We believe that this analysis will provide valuable data such as determining variables associated with urodynamic progression and elapsed time before renal deterioration (hydronephrosis/decreased function) occurs.

We reviewed all patients urodynamic and clinical records in our clinic between 16 and 30 years old. To date, 25 patients have been analyzed. Of the 25 patients with SB 14 were male and 11 were female. Variables collected include type of dysraphism, level, bladder management, continence status, urodynamic parameters, presence of hydronephrosis, and renal function.

Results showed UDS deterioration in terms of reduced capacity, compliance, leakage and detrusor over activity (DOA). Capacity reduction was observed in 14 out of 25 patients. Eight Patient experienced bladder compliance reduction, where 5 of them were still within normal range. Ten patients had constant leakage and 3 had developed leakage after achieving continence. Nine patients were observed to have constant DOA and 3 showed worsening DOA from a stable state. Six out of 10 Patients who were on Anticholinergics medication showed improvement in UDS findings. However, 10 out of 15 patients who were not on medication/non-compliant showed worsening results. Eight out of 9 patients who underwent urological interventions showed improvement in some UDS parameters but 1 of them deteriorated again.

Deterioration in urodynamics was observed over time in SB patients. Surgical interventions helped to improve some of the UDS parameters and patient quality of life.  However, Non-compliance to medication was observed to have a major role in deterioration of urodynamic parameters in these patients. While the number of patients and urodynamics studies is still insufficient, regular urodynamics monitoring and compliance to medication were important factors to determine the progress in these patients.

Regular urodynamics studies during the clinical follow-up of SB patients are important to identify any deterioration in SB patients that warrant intervention in order to protect, in particular, the kidneys, urinary tracts, and bladder from irreversible functional and morphological damage. We believe this data will become the basis for valuable prognostic counselling. However, these studies should be performed using larger patient groups.