RESUMO
To review the uronephrological outcomes of myelomeningocele [MMC] patients attending a Spina Bifida Clinic. We retrospectively reviewed the medical records of all patients from the combined Spina Bifida Clinic, at King Khalid University Hospital, Riyadh, Saudi Arabia between 1999 and 2009 who had at least one year of follow-up with us. We examined their demographic data, uronephrological status at presentation, most recent follow-up, and the rate of surgical intervention. During the 10-year period, 188 patients were actively followed-up. The mean age at presentation was 5.3 years +/- 3.6 SD. At their last follow-up, 109 patients [58%] were using clean intermittent catheterization, 44[23%] had received BotoxR injections, and 26 [14%] had undergone bladder reconstruction. Most [66%] patients were older than 3 years when they presented to us; this group had a significantly higher rate of surgical intervention [BotoxR or reconstruction] compared with those who came to us earlier [p=0.003 for patients receiving BotoxR injections, and p=0.025 for patients undergoing bladder reconstruction].Our multidisciplinary Spina Bifida Clinic is an integral part of MCC management to reach a safe urological outcome. Early presentations to our clinic resulted in a lesser need for surgical intercession compared with those who presented at more than 3 years old.
RESUMO
To determine the applicability, acceptance, and compliance of the option of clean intermittent catheterization [CIC] when needed by patients in our society. We retrospectively reviewed the files of all patients for whom CIC was conducted at King Khalid University Hospital and Security Forces Hospital, Riyadh, Saudi Arabia, between 1998, and 2006. We considered primary pathology, indication of CIC, age at CIC initiation, and who administered the CIC. We also documented the acceptance and compliance levels of the procedure by the patient over time. We included 280 patients, of which 118 [42%] were female and 162 [58%] were male in this study. The main pathology was myelodysplasia in 196 [70%] patients, posterior urethral valve in 52 [18.6%] patients, and non-neuropathic bladder sphincter dysfunction in 32 [11.4%] patients. The mean age was 6.49 +/- 4.25 years. Two hundred and fifty-seven [91.7%] families and their children accepted the idea of CIC, and 248 [88.6%] continued with the CIC program. Mothers were responsible for carrying out the procedure in 204 [72.9%] patients. However, in 76 [27.1%] cases, the patient was doing the procedure independently and the average age for a child to master the technique was 8 years. During the last 3 years, an urotherapist took over the educational services and performed outpatient education instead of our previous inpatient education. Clean intermittent catheterization is an appropriate method of treatment for our group of patients. They showed excellent acceptance of and compliance with the procedure, however, we suggest that for complete success, proper education, teaching, and follow-up should be conducted