Impact of untethering of the spinal cord on urological management and antibiotic stewardship among spina bifida patients in Malaysia

Abstract

Background The incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other neurological problems. It occurs in patients with spina bifida and the authors of this study sought to determine the effects of untethering on the urological outcome of children with a tethered cord and thus identifying proper urological management for individuals with spina bifida. Methods Demographic and clinical data were collected via an online questionnaire and convenient sampling technique were used. 49 spina bifida individuals participated in this study. Results The diagnosis of UTIs is dependent on patients reporting cloudy and smelly urine (67%) and urine validation (60%). 18% of the respondents claimed to have been prescribed antibiotics even though they had no history of UTI. Indiscriminate prescription of antibiotics by healthcare workers further compounds the severity of UTI. Employing CISC (73%) including stringent usage of sterile catheters (71%) did not prevent patients from getting UTI. Overall, 33% of our respondents reported manageable control of UTI (0 – 35 years of age). All individuals below the age of 5 (n=14) had improved urological outcome due to the untethering surgery under the guidance of the Malaysia NTD support group. Conclusion Spina bifida individuals may procure healthy bladder and bowel continence for the rest of their lives provided that neurosurgical and urological treatment being instigated soon after birth and continuing into adulthood.