Paul W. Veenboer

Upper and lower urinary tract outcomes in adult myelomeningocele patients: a systematic review.

Background The introduction of sophisticated treatment of bladder dysfunction and hydrocephalus allows the majority of SB patients to survive into adulthood. However, no systematic review on urological outcome in adult SB patients is available and no follow-up schemes exist. Objectives To systematically summarize the evidence on outcome of urinary tract functioning in adult SB patients. Methods A literature search in PubMed and Embase databases was done. Only papers published in the last 25 years describing patients with open SB with a mean age >18 years were included. We focused on finding differences in the treatment strategies, e.g., clean intermittent catheterization and antimuscarinic drugs versus early urinary diversion, with regard to long-term renal and bladder outcomes. Results A total of 13 articles and 5 meeting abstracts on urinary tract status of adult SB patients were found describing a total of 1564 patients with a mean age of 26.1 years (range 3–74 years, with a few patients <18 years). All were retrospective cohort studies with relatively small and heterogeneous samples with inconsistent reporting of outcome; this precluded the pooling of data and meta-analysis. Total continence was achieved in 449/1192 (37.7%; range 8–85%) patients. Neurological level of the lesion and hydrocephalus were associated with incontinence. Renal function was studied in 1128 adult patients. In 290/1128 (25.7%; range 3–81.8%) patients some degree of renal damage was found and end-stage renal disease was seen in 12/958 (1.3%) patients. Detrusor-sphincter dyssynergy and detrusor-overactivity acted as adverse prognostic factors for the development of renal damage. Conclusions These findings should outline follow-up schedules for SB patients, which do not yet exist. Since renal and bladder deterioration continues beyond adolescence, follow-up of these individuals is needed. We recommend standardization in reporting the outcome of urinary tract function in adult SB patients.

Enterocystoplasty vs Detrusorectomy: Outcome in the Adult with Spina Bifida

PURPOSE Bladder augmentation by enterocystoplasty or detrusorectomy might prevent renal damage, help achieve dryness and decrease the need for antimuscarinics. We compared the long-term outcomes of enterocystoplasty and detrusorectomy in adults with spina bifida. MATERIALS AND METHODS A retrospective study using the hospital electronic database was performed. We identified 47 patients with spina bifida (median age at followup 26.8 years) who underwent either enterocystoplasty or detrusorectomy between 1988 and 2004. Median followup was 13.1 years in the detrusorectomy group and 15.3 years in the enterocystoplasty group. RESULTS In the detrusorectomy group 4 patients with treatment failure were identified. All 4 patients underwent secondary enterocystoplasty. No reoperation was necessary in the enterocystoplasty group. Preoperative bladder volume was approximately 100 ml higher in the detrusorectomy group (not significant). There was a significantly greater improvement of median bladder volume in the enterocystoplasty group (increase of 300 vs 77.5 ml, p = 0.006). No differences in continence rate, antimuscarinic use or condition of the upper tract were found. CONCLUSIONS In this series of 47 patients long-term outcomes were good after enterocystoplasty and detrusorectomy, although bladder volume exhibited a greater increase in the enterocystoplasty group. No differences were observed among the other outcomes. If preoperative bladder volume is sufficient, detrusorectomy can be considered before enterocystoplasty is done.

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

To describe the long‐term upper (UUT) and lower urinary tract (LUT) outcomes in patients with closed spinal dysraphism (CSD). CSD differs from open spinal dysraphism (OSD) by its long asymptomatic course and consequent later diagnosis. The outcome of UUT and LUT function in adults with CSD is relatively unknown.

Behavioral Effects of Long-Term Antimuscarinic Use in Patients with Spinal Dysraphism: A Case Control Study

PURPOSE We explored possible associations between long-term antimuscarinic use and behavioral problems in children with spinal dysraphism and neurogenic bladder. MATERIALS AND METHODS Children with open and closed spinal dysraphism were recruited from 2 pediatric hospitals, 1 in Amsterdam and 1 in Utrecht, The Netherlands. At the Amsterdam facility antimuscarinics were prescribed in selected patients with detrusor overactivity. At the Utrecht facility antimuscarinics were prescribed from birth onward in patients with spinal dysraphism beginning in the early 1990s. Parents of study participants were asked to fill out a Child Behavior Checklist. Demographics, data on level and type(s) of lesion, and presence of hydrocephalus with a drain (and, if applicable, number of drain revisions) were retrieved for each patient. Cases and controls (8 boys and 8 girls per group) were matched on a 1-to-1 basis. RESULTS Data on 32 children were analyzed. Median age was 10.6 years in cases and 10.5 years in controls (p=0.877). In each group 9 of 16 patients had hydrocephalus with a drain. No significant difference in Child Behavior Checklist scores for total problems was found between cases and controls (median 52.0 vs 59.5, p=0.39). No differences were found between the groups on any subdomain of the Child Behavior Checklist. CONCLUSIONS No significant differences in behavior were found between children with spinal dysraphism with and without long-term use of antimuscarinics.

Diagnostic accuracy of Tc-99m DMSA scintigraphy and renal ultrasonography for detecting renal scarring and relative function in patients with spinal dysraphism

To study additional benefits of performing Tc‐99m dimercaptosuccinic acid (Tc‐99m‐DMSA) scintigraphy as part of the follow‐up of adults with spinal dysraphism (SD), compared with ultrasonography, with regard to finding renal scarring and difference in split renal function.

Electroejaculation in psychogenic anejaculation

OBJECTIVE To evaluate the results of treatment with electroejaculation (EEJ), intrauterine insemination (IUI), and IVF/intracytoplasmic sperm injection (IVF/ICSI) in patients with psychogenic anejaculation (PAE). DESIGN Retrospective clinical study. SETTING Academic tertiary referral fertility center. PATIENT(S) Eleven male patients diagnosed with psychogenic anejaculation (PAE) were included. Median age at the time of first treatment with EEJ was 33.0 (interquartile range, 29.0-36.0) years. INTERVENTION(S) Electroejaculation, IUI, and IVF/ICSI. MAIN OUTCOME MEASURE(S) Semen analysis, fertilization rate, implantation rate, pregnancy rate, and delivery rate. RESULT(S) A total of 60 EEJs were performed in 11 patients. Mean VCM (volume [mL] × concentration [sperm cells/mL] × percentage progressive motile cells) of the retrieved sperm of all EEJs was 17.5 × 10(6) (SD 16.5 × 10(6)). Yielded semen was used in a total of 26 ICSI procedures in seven couples. The fertilization rate was 65.6% (80 of 122). The ICSI cycles resulted in five pregnancies; of these, one resulted in a spontaneous abortion in the first trimester. Three couples were treated with 34 IUI cycles, which resulted in live births in four pregnancies. CONCLUSION(S) Electroejaculation is a suitable and effective treatment that can be used in men with psychogenic anejaculation. The retrieved semen can be used successfully in assisted reproductive technology treatment. In this study EEJ resulted in pregnancies and the birth of eight healthy children.

Spinal cord transection before scoliosis correction in myelomeningocele may improve bladder function

In patients with myelomeningocele (MMC) and coexistent scoliosis, a spinal cord transection (SC‐transection) is sometimes performed before scoliosis correction to prevent traction on the myelum after stretching the spinal column. Performing a SC‐transection may have positive effects on bladder function, especially in case of refractory detrusor‐sphincter dyssynergia. This study investigates the effects of SC‐transection on lower and upper urinary tract outcomes.

Medical and psychosocial problems in middle-aged spina bifida patients: survey among members of the Dutch patients’ association

Abstract Purpose: To identify physical, emotional and psychosocial issues in the older person with spina bifida (SB). Method: Members of the Dutch patients’ association aged >25 years (n = 184) were asked to complete a questionnaire. This survey contained questions on physical and psychosocial complaints, as well as problems regarding social participation. Results: A total of 61 people (33.2%) with a median age of 45 years (IQR 33.5–60.0) years responded. During the previous 5 years, 86.9% experienced new physical complaints, whereas only 13.1% remained free of new complaints. 50.8% of the persons had new bladder problems and 44.1% had bowel complaints. Older persons more often had physical complaints. New musculoskeletal problems occurred in 75.4%. Psychological problems were common (78.7%). Overall psychological problems were not associated with gender, hydrocephalus or age. Social participation was good, with 90.2% of persons taking part in some type of social activity. Conclusions: In this study, a majority of adult persons with SB reported newly arising physical and psychological problems during the previous 5 years. Given the large number and diversity of the newly emerging problems after adolescence, regular and multidisciplinary surveillance of adult persons with SB is recommended. Implications for Rehabilitation Adults with spina bifida often disappear from follow-up, or are forced to take care of their follow-up themselves. According to a survey carried out among adult SB-patients from the general community, these persons continued to struggle with many physical and psychosocial problems. Given the high number of psychosocial problems in this sample of patients, psychosocial counseling could be beneficial during follow-up. This paper adds to the body of evidence indicating that multidisciplinary follow-up for SB-patients could be beneficial, also when patients grow beyond the age of 18 years.

Electroejaculation in patients with spinal cord injuries: A 21-year, single-center experience

To evaluate treatment results of electroejaculation in patients with spinal cord injuries and the additional value of repeated electroejaculation.

Samenvatting van de nieuwe Nederlandse richtlijn urine-incontinentie

SamenvattingDit artikel vat de aanbevelingen uit de ‘Richtlijn Urine-incontinentie’ samen. Deze richtlijn is een voor de Nederlandse situatie aangepaste versie van de evidence-based ‘EAU Guideline on Urinary Incontinence’ uit 2013. Zowel diagnostiek, conservatieve (niet-medicamenteuze en medicamenteuze) behandeling als chirurgie komt uitvoerig aan bod. Al deze aanbevelingen hebben als doel de zorg voor patiënten met urine-incontinentie in de tweede en derde lijn richting te geven. Voor uitvoerige beschrijvingen van de literatuur en gebruikte methoden wordt verwezen naar de eigenlijke richtlijn. Deze is te vinden op de website van de NVU (www.nvu.nl).SummarySummary of the new Dutch guidelines on urinary-incontinenceThis paper summarizes the recommendations made in the new Dutch ‘Richtlijn Urine-incontinentie’ (Guidelines on Urinary Incontinence). These guidelines are based upon the 2013 EAU Guidelines on Urinary Incontinence. Diagnosis, conservative treatment, medical treatment and surgical treatment are thoroughly discussed. All these recommendations serve to guide the care for patients in second and third line centers. Thorough discussions on the literature are not included in this summary article; those interested in the literature upon which the recommendations are based should read the Guidelines (which can be found at www.nvu.nl).