The Outcome Of Neurogenic Bladder Dysfunction In Congenital And Acquired Spinal Cord Lesion: The Urotherapist Role In A Spina Bifida Unit
PURPOSE Congenital or acquired spinal cord lesions (SCL) result in a serious physical disability, reducing quality of life and restricting social activities. We conducted this prospective study to define the role of urotherapist in a multisciplinary approach to neurogenic bladder dysfunction (NBD) in a Spina Bifida Unit. MATERIAL AND METHODS 25 children, 16 males and 9 females, aged 0.1-16.3 years with acquired SCL and 29 children, 13 males and 16 females, aged 0.5-17,2 years, with spina bifida (SB) were evaluated. In all patients a complete neuro-urological evaluation was performed considering pad use, diaries, renal ultrasound, video-urodynamics. NBD were classified according to International Children Continence Society criteria. The neuro-urological therapeutich approach was evaluated in all patients considering: clean intermittent catheterization (CIC) or self administered CIC, pharmacotherapy, endoscopic and surgical treatment. Psychological and familiar dynamics was evaluated using CBCL as well as clinical neurological using ASIA and SCIM scale, and quality of life (QOL) was evaluated too. RESULTS Motor disability was related to lesion site and it was worse in acquired than congenital SCL. Quadriplegic patients and children CONCLUSIONS Loss of sphincters control influenced patients and relatives quality of life more than motor disability. A multidisciplinary approach facilitates the maximum recovery level. Urotherapists play a main role to understand and answer to families's and patients's requests.