From the Guidelines
For a new patient presenting with possible spina bifida and urinary incontinence, I would first take a comprehensive history and perform a detailed physical exam, including a thorough neurological assessment, as recommended by the most recent guideline on adult neurogenic lower urinary tract dysfunction 1. The initial evaluation should include a detailed history, physical exam, and urinalysis, as stated in the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction 1. This approach is critical in directing subsequent evaluation and management of patients with neurogenic lower urinary tract dysfunction.
Key Components of the Initial Evaluation
- Comprehensive history focusing on urinary symptoms, bowel function, neurological symptoms, and developmental history
- Physical examination, including:
- Thorough neurological assessment (lower extremity strength, sensation, reflexes)
- Examination of the spine for cutaneous markers of spina bifida (dimples, tufts of hair, hemangiomas)
- Assessment of gait and evaluation of perineal sensation and anal tone
- Urinalysis to rule out infection or other abnormalities
Additional Diagnostic Tests
Urodynamic testing is recommended to assess bladder function, as it provides valuable information on the specific neurourological dysfunction present in each individual patient 1. Other tests that may be considered include:
- MRI of the spine to evaluate for tethered cord or other spinal abnormalities
- Renal ultrasound to check for hydronephrosis or other kidney abnormalities
- Post-void residual measurement to assess bladder emptying
- Video urodynamics for more detailed assessment of lower urinary tract function, if necessary
Importance of a Comprehensive Approach
The management of incontinence in patients with spina bifida requires a comprehensive approach, taking into account the potential effects of the condition on multiple body systems 1. A thorough initial evaluation is essential to direct subsequent management and ensure the best possible outcomes for patients with neurogenic lower urinary tract dysfunction.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnostic Steps for Spina Bifida and Urinary Incontinence
The diagnostic steps for a new patient presenting with possible spina bifida and urinary incontinence involve a combination of physical examination, medical history, and specialized tests.
- A neurological examination to assess motor and sensory function, as well as to identify any signs of upper or lower motoneuron lesions 2
- A urinary questionnaire to gather information about the patient's urinary symptoms, such as frequency, urgency, and incontinence 2
- Urodynamic studies to evaluate bladder function and identify any abnormalities, such as detrusor hyperreflexia or low compliance detrusor 2, 3
- Imaging studies, such as spinal magnetic resonance imaging (MRI) or myelography, to confirm the diagnosis of spina bifida and to assess the extent of the spinal anomaly 2
Specialized Tests
Specialized tests may be ordered to further evaluate the patient's condition, including:
- Clean intermittent catheterization (CIC) to assess bladder emptying and to identify any urinary tract infections 4
- Laboratory tests, such as urine analysis and blood tests, to rule out other conditions that may be contributing to the patient's symptoms 4
- Sacral neuromodulation (SNM) to evaluate the effectiveness of this treatment for neurogenic bladder and bowel dysfunction in patients with spina bifida 5
Management and Treatment
The management and treatment of spina bifida and urinary incontinence depend on the severity of the condition and the patient's individual needs.
- Medical management may include medications to manage urinary symptoms, such as anticholinergics or beta-3 adrenergic agonists 4
- Surgical interventions, such as bladder augmentation or artificial urinary sphincter implantation, may be necessary to achieve urinary continence 6, 3
- Lifestyle modifications, such as dietary changes and pelvic floor exercises, may also be recommended to help manage urinary symptoms 6