Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina Bifida

Wang, Hsin-Hsiao S.; Lloyd, Jessica; Wiener, John S.; Routh, Jonathan C.

doi:10.1016/j.juro.2015.11.033

Cited by 33 publications

(20 citation statements)

References 20 publications

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“…We then compared those with (62) and without (20) imaging in the first year of life ( Table 1). There was a higher proportion of patients with a diagnosis of lipomeningocele (p=0.02) in the group without imaging.…”

Section: Resultsmentioning

confidence: 99%

“…When comparing hydronephrosis incidence, VUR status, CIC/AC rates, surgical incidence, and estimated GFR, we found no meaningful differences in any of these outcomes However, there was a higher rate of AC use in those with initial imaging (p=0.01). Those (20) patients without imaging in the first year of life were likely not recognized until sometime (months, or years) after birth, given the higher proportion of lipomeningocele.…”

Section: Resultsmentioning

confidence: 99%

“…Wang et al reviewed nationwide trends in chronic renal insufficiency (CRI) and urologic surgery over time within the SB population [20]. Interestingly, SB admissions with the diagnosis of CRI has progressively increased from 6 % in 1998 to 12 % in 2011.…”

Section: Discussionmentioning

confidence: 99%

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Radiographic abnormalities, bladder interventions, and bladder surgery in the first decade of life in children with spina bifida

et al. 2019

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Spina bifida (SB) patients are at increased risk for hydronephrosis (HN), bladder storage and emptying problems, and renal failure that may require multiple bladder surgeries to address. We use early renal/bladder ultrasound (RBUS) and fluoroscopic urodynamic images (FUI) to guide therapies (clean intermittent catheterization (CIC), anticholinergic use (AC), and/or surgical interventions (SI)). We analyzed initial and 10-year radiologic findings, renal function (RF), and CIC, AC and SI rates for children followed proactively and consistently. Materials/Methods: We retrospectively reviewed all born with SB between 2005 and 2009, presenting to our institution within 1 year of birth. Outcomes at 8-11 years old included final RBUS results, CIC use, AC use, any SIs prior to final follow-up, and final RF. We excluded those without follow-up past age 8, and/or no RBUS or FUI within first year of birth. All RBUS and FUI were performed at our institution. Imaging was independently reviewed by 4 pediatric urologists blinded to radiologists' interpretation. McNemar's test was used to compare initial findings (RBUS results, FUI, CIC, AC) with final outcomes at 8-11 years of age (RBUS, CIC, AC, SI, and RF). FUI was too infrequent at the final (8-11 years) window, and not included. Serum creatinine and cystatin-C were used to estimate GFR. Results: Of 98 children, we excluded 16 without adequate follow-up (left referral area), and 20 for lack of available imaging within 1 year of birth (born elsewhere). 62 children remained for analysis: (48 % male, 76 % shunted). Median age at last follow-up was 9.6 years. Upon initial imaging, 74 % of children had HN (≥ SFU grade 1), this decreased to 5 % at 10 years (p<0.0001). Initially, 9 % had ≥ SFU grade 3 HN, this decreased to 2 % (p=0.13). CIC and AC ____________________________________________________

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Radiographic abnormalities, bladder interventions, and bladder surgery in the first decade of life in children with spina bifida

et al. 2019

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“…This surgery is often performed to protect the kidneys; as expected, the rate of bladder surgery was inversely correlated, both geographically and temporally, with the rate of renal insufficiency admissions among SB patients. 14 …”

Section: Discussionmentioning

confidence: 99%

Bladder Reconstruction Rates Differ among Centers Participating in National Spina Bifida Patient Registry

et al. 2018

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“…4,5 However, the optimal urological care of SB related bladder dysfunction is currently unknown. 6 There has been a recent trend toward proactive rather than reactive management of children with SB, although this shift is not well supported by evidence. 4,5 This situation raises the possibility that urological care of children with SB can be further optimized, potentially leading to improvements in continence, prevention of chronic renal insufficiency and decreased need for surgery.…”

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confidence: 99%

Design and Methodological Considerations of the Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida

et al. 2016

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Purpose Care of children with spina bifida has significantly advanced in the last half century, resulting in gains in longevity and quality of life for affected children and caregivers. Bladder dysfunction is the norm in patients with spina bifida and may result in infection, renal scarring and chronic kidney disease. However, the optimal urological management for spina bifida related bladder dysfunction is unknown. Materials and Methods In 2012 the Centers for Disease Control and Prevention convened a working group composed of pediatric urologists, nephrologists, epidemiologists, methodologists, community advocates and Centers for Disease Control and Prevention personnel to develop a protocol to optimize urological care of children with spina bifida from the newborn period through age 5 years. Results An iterative quality improvement protocol was selected. In this model participating institutions agree to prospectively treat all newborns with spina bifida using a single consensus based protocol. During the 5-year study period outcomes will be routinely assessed and the protocol adjusted as needed to optimize patient and process outcomes. Primary study outcomes include urinary tract infections, renal scarring, renal function and bladder characteristics. The protocol specifies the timing and use of testing (eg ultrasonography, urodynamics) and interventions (eg intermittent catheterization, prophylactic antibiotics, antimuscarinic medications). Starting in 2014 the Centers for Disease Control and Prevention began funding 9 study sites to implement and evaluate the protocol. Conclusions The Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida began accruing patients in 2015. Assessment in the first 5 years will focus on urinary tract infections, renal function, renal scarring and clinical process improvements.

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Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina Bifida

Cited by 33 publications

References 20 publications

Radiographic abnormalities, bladder interventions, and bladder surgery in the first decade of life in children with spina bifida

Radiographic abnormalities, bladder interventions, and bladder surgery in the first decade of life in children with spina bifida

Bladder Reconstruction Rates Differ among Centers Participating in National Spina Bifida Patient Registry

Design and Methodological Considerations of the Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida

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