Longitudinal Study of Bladder Continence in Patients with Spina Bifida in the National Spina Bifida Patient Registry
Longitudinal Study of Bladder Continence in Patients with Spina Bifida in the National Spina Bifida Patient Registry
复制标题
DOI：
10.1016/j.juro.2017.11.048
复制
发表时间：
2018-03-01
影响因子：
6.6
通讯作者：
Valdez, Rodolfo
中科院分区：
文献类型：
--
作者：
Liu, Tiebin;Ouyang, Lijing;Valdez, Rodolfo
目的：在脊柱裂患者中实现膀胱控制是一个终生的管理目标。我们调查了脊柱裂患者膀胱失禁状态的时间和相关因素。材料和方法：我们使用2009年至2015年收集的国家脊柱裂患者登记处的数据，应用广义估计方程模型分析与膀胱失禁状态相关的因素。结果：这项分析包括了5250名脊柱裂患者，他们来自一个大型的、多机构的患者登记处，在研究期间有12740例年度门诊就诊记录。最后随访的平均年龄为16.6岁，22.4%的参与者接受了膀胱失禁手术，92.6%的参与者使用了某种形式的膀胱管理，45.8%的参与者报告了膀胱失禁。在多变量回归模型中，膀胱失禁的可能性在年龄较大、女性、非西班牙裔白人、诊断为非脊膜膨出、病变程度较低、活动水平较高、有私人保险的人群中显著增加。失禁手术史和当前处理也与失禁相关，独立于所有其他因素（调整OR和95% CI分别为1.9,1.7-2.1和3.8,3.2-4.6）。诊断为脊髓脊膜膨出的患者膀胱管理与尿失禁之间的相关性（调整OR为4.6）强于非脊髓脊膜膨出的患者（调整OR为2.8）。结论：除人口统计学、社会和临床因素外，手术干预和膀胱管理与脊柱裂患者膀胱失禁状况有显著且独立的相关性。在脊髓脊膜膨出患者中，膀胱管理与尿失禁之间的联系更强。
Purpose: Achieving bladder continence in individuals with spina bifida is a lifetime management goal. We investigated bladder continence status through time and factors associated with this status in patients with spina bifida.Materials and Methods: We used National Spina Bifida Patient Registry data collected from 2009 through 2015 and applied generalized estimating equation models to analyze factors associated with bladder continence status.Results: This analysis included 5,250 participants with spina bifida in a large, multi-institutional patient registry who accounted for 12,740 annual clinic visit records during the study period. At last followup mean age was 16.6 years, 22.4% of participants had undergone bladder continence surgery, 92.6% used some form of bladder management and 45.8% reported bladder continence. In a multivariable regression model the likelihood of bladder continence was significantly greater in those who were older, were female, were nonHispanic white, had a nonmyelomeningocele diagnosis, had a lower level of lesion, had a higher mobility level and had private insurance. Continence surgery history and current management were also associated with continence independent of all other factors (adjusted OR and 95% CI 1.9, 1.7-2.1 and 3.8, 3.2-4.6, respectively). The association between bladder management and continence was stronger for those with a myelomeningocele diagnosis (adjusted OR 4.6) than with nonmyelomeningocele (adjusted OR 2.8).Conclusions: In addition to demographic, social and clinical factors, surgical intervention and bladder management are significantly and independently associated with bladder continence status in individuals with spina bifida. The association between bladder management and continence is stronger in those with myelomeningocele.