1. Risk of prolapse and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor using clean intermittent catheterization versus Valsalva voiding
- Author
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C. Richard, Charlène Brochard, Jacques Kerdraon, Laurent Siproudhis, Xavier Gamé, Zine-Eddine Khene, Isabelle Bonan, Quentin Alimi, M. Jezequel, Andrea Manunta, Juliette Hascoet, Mehdi El Akri, B. Peyronnet, CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Mutualiste de Rééducation et de Réadaptation Fonctionnelles de Kerpape, CHU Toulouse [Toulouse], Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
- Subjects
Adult ,Male ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Urology ,Urinary system ,030232 urology & nephrology ,acontractile ,urologic and male genital diseases ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Uterine Prolapse ,Intussusception (medical disorder) ,Urinary Bladder, Underactive ,Clinical endpoint ,Humans ,Medicine ,Intermittent Urethral Catheterization ,Urinary Complication ,Urinary Bladder, Neurogenic ,Spinal Dysraphism ,Retrospective Studies ,valsalva pelvic organ prolapse ,030219 obstetrics & reproductive medicine ,Urinary bladder ,business.industry ,Spina bifida ,clean-intermittent catheterization ,medicine.disease ,spina bifida ,body regions ,Rectal prolapse ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Relative risk ,Urinary Tract Infections ,Female ,Neurology (clinical) ,urinary tract infection ,business ,urinary bladder ,rectal prolapse - Abstract
International audience; Aims - To assess the relative risks of pelvic organ prolapse (POP) and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor voiding with Valsalva versus those using clean-intermittent catheterization (CIC). Methods - We conducted a retrospective analysis including all spina bifida patients with neurogenic acontractile detrusor with a minimum follow-up of 12 months. Patients were then divided in two groups according to their bladder management: voiding with Valsalva versus CIC. The primary endpoint was any de novo or worsened rectal and/or pelvic organ prolapse (POP) diagnosed during follow-up. The secondary outcome was urinary complications defined as febrile urinary tract infections (UTI) and/or urolithiasis and/or renal failure. Results - Fifty-five patients (50.9% were males) met the inclusion/exclusion criteria: 28 voiding with Valsalva and 27 performing CIC. At baseline, the rates of vaginal prolapse (44.4% vs 50%; P = 0.99), and rectal prolapse/intussusception (25.9% vs 21.4%; P = 0.76) were similar in both groups. After a median follow-up of 80.6 and 65.6 months, respectively (P = 0.29), the rate of de novo or worsened rectal prolapse/intussusception was higher in the Valsalva voiding group than in the CIC group (32.1% vs 3.7%; P = 0.01). De novo or worsened vaginal prolapses were also more common in the Valsalva voiding group, but it did not reach statistical significance (33.3% vs 11.1%; P = 0.29). Conclusions - Valsalva voiding might be harmful in adult spina bifida patients with neurogenic acontractile detrusor as it may increase the risk of rectal prolapse/intussusception. Overall, the prevalence of POP and rectal prolapse was high in both groups.
- Published
- 2018