Abstract General Information

Title

EVALUATION OF THE URONEPHROLOGICAL CARE PROCESS IN PATIENTS WITH SPINA BIFIDA IN A HIGH COMPLEXITY HOSPITAL.

Introduction and objective

The vast majority of patients with spina bifida require a proactive approach. The implementation of this is sometimes not possible, especially cases referred from other centers to highly complex hospitals. Objectives: To describe the uronephrological evaluation and treatment received by patients with myelomeningocele referred and internal cases.

Method

A retrospective, longitudinal study with a clinical, analytical design was conducted in patients with MMC between 1 months and 18 years of age referred to high complexity hospital for outpatient care for a period of 12 months. The indication for complementary studies and urological treatment was evaluated. We compared renal function in the external group against the group of internal patients of our center.

Results

Of a total of 170 patients, 115 cases were referred to our center. Of these, 7% had received a complete nephrourological evaluation (kidney-bladder ultrasonography, urodynamic studies, cystourethrography, renal scintigraphy DMSA, and creatininemia levels). Treatment: 33% emptied their bladder by CIC or vesicostomy and 21% received oral oxybutynin. From follow-up initiation at our Hospital, 83% underwent complete evaluation, and based on the results CIC was indicated in 87% and oxybutynin in 66% of the patients. On admission, prevalence of chronic kidney disease was 43%; with stage I in the majority of the patients. The remaining 55 patients were admitted to our center in the first days of life and a proactive approach was implemented in them. The prevalence of chronic kidney disease in these last cases was 36% at 5 years old (n: 55).
The maternal level of education, the distance to the care center and/or the type of coverage did not affect compliance with the proposed study plan.

Conclusion

The majority of the patients with MMC were referred to a third-level hospital with incomplete urological studies without full treatment of the neurogenic bladder and with more than 40% renal involvement. Initiation on time of interdisciplinary follow-up and conexion with a tertiary hospital allowed for the necessary studies and implementation of adequate treatment with less chronic kidney disease.