From the Guidelines
Spina bifida in a 34-year-old requires comprehensive management focused on addressing specific complications and maintaining function, with a priority on preventing morbidity, mortality, and improving quality of life. Regular follow-up with a multidisciplinary team including neurology, urology, orthopedics, and rehabilitation medicine is essential, as noted in studies such as 1 and 1. For urinary issues, clean intermittent catheterization (CIC) 4-6 times daily is often needed, along with anticholinergics like oxybutynin (5mg three times daily) or tolterodine (2mg twice daily) for neurogenic bladder, as discussed in 1.
Key aspects of management include:
- Urinary management: CIC, anticholinergics
- Bowel management: high-fiber diet, adequate hydration, medications like polyethylene glycol or bisacodyl suppositories
- Mobility: physical therapy, assistive devices
- Pressure ulcer prevention: regular position changes, skin checks
- Pain management: gabapentin for neuropathic pain, standard analgesics for musculoskeletal pain
- Mental health support
These interventions address the neurological, urological, orthopedic, and psychological aspects of adult spina bifida, focusing on preventing complications and maintaining quality of life rather than correcting the congenital defect itself, as emphasized in 1 and 1. Transition of care to adulthood remains a critical aspect of disease management, requiring attention to independence, self-care, and long-term support, as highlighted in 1.
From the Research
Spina Bifida Overview
- Spina bifida is a congenital deformity that is frequently seen in infancy, but its effects can be lifelong 2.
- The most clinically significant subtype is myelomeningocele, which is a condition characterized by failure of the lumbosacral spinal neural tube to close during embryonic development 2.
Urodynamic Changes and Treatment
- Neuro-urological problems are highly important for patients with spina bifida in terms of both social and medical aspects 3.
- The most frequent urodynamic changes in patients with spina bifida are hyperactive detrusor activity and detrusor sphincter dyssynergy preoperatively 3.
- Surgical treatment, such as untethering, can improve urodynamic changes and clinical courses in patients with spina bifida 3, 4.
Age and Outcome
- Younger age, particularly less than or equal to 2 years, is a positive prognostic factor for improvement in symptoms after untethering 5.
- The functional outcome is determined by the age at surgery, with younger patients having a higher chance of gaining a favorable outcome 5.
Management and Care
- Early recognition and comprehensive care can improve long-term health, well-being, and quality of life in individuals with spina bifida 6.
- A periodicity schedule can simplify current spina bifida guidelines and make them easier to use for practitioners and families 6.
- Regular follow-up and investigations using electrophysiologic and urodynamic studies are helpful for early detection of subtle symptomatic cord tethering or retethering 5.