Urologic Disorders are Still the Leading Cause of In-hospital Death in Patients With Spina Bifida

Abstract

Objective To assess and analyze the contemporary causes of inhospital deaths of spina bifida patients. Methods It was a cross-sectional observational study of the longitudinal national cohort of all patients hospitalized in French public and private hospitals. We analyzed the data from the French hospital discharge database (Programme de Médicalisation des Systemes d'Information, PMSI) from 2009 to 2014. The number of inhospital deaths was extracted using the combination of the ICD-10 codes "Q05" or "Q760" and a discharge code=9. Results There were 138 inhospital deaths of spina bifida patients over the 6-year study period. The median age at death was 41 years (IQR: 25-52). The median age at death was significantly lower in patients with vs. without hydrocephalus (26.6 vs. 45.5 years; p<0.0001). The leading cause of inhospital death was urological disorders (n=24; 17.3%). Other main causes of death were pulmonary disorders (n=23; 16.7%), neurological disorders (n=19; 13.8%) and bowel disorders (n=15; 10.9%). Upper urinary tract damage accounted for most of the urological causes of death: eight patients died from urinary tract infections (33.3%), seven patients died from renal failure (29.2%), four died from bladder cancer (16.7%) and five from other urological causes. The only variable significantly associated with a death from urological causes was the absence of hydrocephalus (OR=0.26; p=0.009). Conclusion Urological disorders remain the leading cause of inhospital death in spina bifida patients in France. The present study highlights that efforts to improve the urological management of the spina bifida population are still greatly needed.

Long‐term outcomes of artificial urinary sphincter in female patients with spina bifida

“…Spina bifida is a common congenital neuroembryological disorder affecting multiple organ systems 1 . Urological disorders can be a significant source of morbidity and mortality in spina bifida patients 14 . SUI is frequent in spina bifida patients and significantly affects their quality of life.…”

“…1 Urological disorders can be a significant source of morbidity and mortality in spina bifida patients. 14 SUI is frequent in spina bifida patients and significantly affects their quality of life. Several options exists for its management but still no clear guidelines are available due to scarce data in the literature regarding SUI treatment in the specific subset of neurological patients.…”

The rationale for bladder washouts in children with neurogenic bladder

“…In patients with a neurogenic bladder, UTIs are the most common cause of hospitalization. Furthermore, kidney failure is a significant cause of morbidity and mortality in patients with spina bifida 4,5 . Half of children with spina bifida have had a UTI by 15 months of age 6 .…”

“…Furthermore, kidney failure is a significant cause of morbidity and mortality in patients with spina bifida. 4,5 Half of children with spina bifida have had a UTI by 15 months of age. 6 Studies have confirmed that 50% of patients with neurogenic bladder have asymptomatic bacteriuria, 7 which increases to 70% if the patient is performing clean intermittent catheterization.…”

Serum exosomal coronin 1A and dynamin 2 as neural tube defect biomarkers

“…Neural tube defects (NTDs) are common congenital malformations that cause severe damage to the fetus as a result of the failure of neural tube closure at 21-28 days after conception [1]. Spina bifida aperta (SBA) is one of the most common types of NTDs and presents with urinary and neurological complications [2]. Moreover, after surgery, long-term follow-up therapy and medical support may be necessary [3].…”