PD10-12 MEDICAL COMPLICATIONS AND UROLOGICAL SURVEILLANCE IN THE UNITED STATES ADULT SPINA BIFIDA POPULATION (2015)

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction II1 Apr 2015PD10-12 MEDICAL COMPLICATIONS AND UROLOGICAL SURVEILLANCE IN THE UNITED STATES ADULT SPINA BIFIDA POPULATION Yahir Santiago-Lastra, Anne P. Cameron, Julie Lai, Christopher Saigal, J. Quentin Clemens, and The NIDDK Urologic Diseases in America Project Yahir Santiago-LastraYahir Santiago-Lastra More articles by this author , Anne P. CameronAnne P. Cameron More articles by this author , Julie LaiJulie Lai More articles by this author , Christopher SaigalChristopher Saigal More articles by this author , J. Quentin ClemensJ. Quentin Clemens More articles by this author , and The NIDDK Urologic Diseases in America ProjectThe NIDDK Urologic Diseases in America Project More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.952AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adult patients with myelomeningocele (MMC) and the associated neurogenic bladder require consistent, lifelong vigilance. Preventing these complications may be possible if adequate surveillance can be implemented for these patients. Our objectives are to evaluate the adequacy of urologic surveillance in this population and to outline the prevalence and risk factors for medical complications. METHODS We performed a retrospective cohort study using a 5% sample of Medicare administrative data from 2007−2010. We used the Paralyzed Veterans of America screening guideline to define the minimum adequacy of surveillance: serum creatinine, upper urinary tract imaging and a urologist visit within a 2−year period. Neurogenic bladder−associated complications and diagnosis of MMC were collected using ICD−9 codes. Complications were graded based on their clinical implications. We completed a multivariate analysis to identify predictors of complications based on severity. We included the following variables: age, gender, race, travel distance to referral center, and geographic location of residence. RESULTS 825 MMC patients were included in our study and were a predominantly Caucasian (85.1%) female population (61.3%) with a mean age of 51.2 +/− 17.2 years. Most patients (61.3%) received some form of neurogenic bladder surveillance, although only 33% of the patients met the minimum acceptable criteria for adequacy. A urologist visit within two years took place for 44% of the patient population. Most complications observed in the patient sample were mild complications, which occurred in 27.6% of patients. Moderate and severe complications were observed in 17.0% and 6.6% of patients, respectively. The most common complications were acute or recurrent cystitis (16.4%), pressure ulcers (7.1%), chronic kidney disease (4.4%), and kidney infection (3.7%). Multivariate analysis showed that the risk factors for increased complications included younger patient age, male gender and better adequacy of neurogenic bladder surveillance. CONCLUSIONS This retrospective sample of patients highlights the opportunity for improvement in surveillance in this susceptible population. The select minority of patients who received adequate observation was diagnosed with a larger number of complications. Disease ascertainment may be better in the adequately screened MMC population. This emphasizes a need for a close watch on this high−risk patient population. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e205 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Yahir Santiago-Lastra More articles by this author Anne P. Cameron More articles by this author Julie Lai More articles by this author Christopher Saigal More articles by this author J. Quentin Clemens More articles by this author The NIDDK Urologic Diseases in America Project More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...