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Paucity of evidence regarding urinary tract outcomes in closed spinal dysraphism: a systematic review.

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Published:25th Mar 2020
Objectives: To describe the long term upper and lower urinary tract outcomes in patients with closed spinal dysraphism. Closed spinal dysraphism (CSD) differs from open spinal dysraphism (OSD) by its long asymptomatic course and consequent later diagnosis. The outcome of upper and lower urinary tract function in adults with CSD is relatively unknown. Patients and Methods: A systematic review was performed following the standards of the PRISMA guidelines. An extensive search was made in PubMed and EMBASE. Included were papers on adults with any form of primary CSD that described bladder and/or kidney function. Only English and Dutch language papers were included. Excluded were papers on patients aged < 18 years and patients with secondary tethered cord following childhood OSD repair. ICS terminology was used to describe lower urinary tract outcomes. Results: Eventually, only seven studies (90 patients) were included and none of these described renal outcomes. Five of the 7 papers were on outcomes after untethering surgery during adulthood. Urological complaints were present in 54/79 (68.4%). Urodynamic studies (UDS) (48 patients available) revealed detrusor underactivity in 46.5% of the evaluated cases, detrusor overactivity was seen in 32.6% and normal findings on UDS were found in 16.3% of studied patients. Symptomatic improvement after surgery for tethered cord occurred in 33.3-90.0%, depending on the subgroup studied. Urodynamic improvement rates ranged from 11.1-54.5% (but based on 3 studies with only 24 patients). Success of surgery depended on the time between onset of symptoms and operation, and (sometimes) type of lesion. Conclusion: Few data are available on long-term urological outcomes in adult patients with CSD. More extensive research on follow-up, including the functional status of the upper tract, is recommended. Based upon the little evidence available, we think life-long follow-up (from birth into adulthood) of those with CSD and neurogenic bladder is advisable.

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