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JU INSIGHT Quality of Life and Bladder Catheterization Route in Youth With Spina Bifida
By: Josephine Hirsch, BA, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; N. Valeska Halstead, MD, MPH, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; Theresa Meyer, RN, MS, CPN, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; James T. Rague, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; Soojin Kim, MD, BC Children’s Hospital, Vancouver, British Columbia, Canada; Ilina Rosoklija, MPH, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; Stephanie Kielb, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Jill E. Larson, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; Vineeta T. Swaroop, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; Robin M. Bowman, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; Earl Y. Cheng, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; Diana K. Bowen, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; Elizabeth B. Yerkes, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois; David I. Chu, MD, MSCE, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois | Posted on: 14 Aug 2024
Hirsch J, Halstead NV, Meyer T, et al. Quality of life and bladder symptoms in adolescents and young adults with spina bifida who catheterize via urethra vs catheterizable channel. J Urol. 2024;212(2):362-371. doi:10.1097/JU.0000000000004013
Study Need and Importance
Adolescents and young adults with spina bifida often require intermittent bladder catheterizations as part of neurogenic bladder management. Most individuals start with catheterizations per native urethra, but some eventually may undergo bladder reconstruction with creation of a continent catheterizable channel. Whether catheterization via channel vs urethra is associated with health-related quality of life, bladder-related quality of life, and bladder symptoms is unknown.
What We Found
In our study, we analyzed prospectively collected patient-reported outcomes on health-related quality of life, bladder-related quality of life, and bladder symptoms in 146 adolescents and young adults with spina bifida, of whom 39 (27%) used a channel and 85 (58%) were female. Urinary incontinence was more common in the urethral group (60%) vs the channel group (33%). In adjusted analyses (Table), catheterization route was not associated with health-related quality of life nor bladder-related quality of life, but catheterization via channel was associated with fewer bladder symptoms. More bladder symptoms were associated with worse bladder-related quality of life.
Table. Multivariable Linear Regression Models Showing Associations Between Catheterization Route and Outcomes of Health-Related Quality of Life, Bladder-Related Quality of Life, and Bladder Symptoms
| Catheterization via urethra | Catheterization via channel β (95% confidence interval) |
|
|---|---|---|
| Health-related quality of life (score 16-67.5, higher = better) |
Referent | 0.68 (−4.08, 5.45), P = .80 |
| Bladder-related quality of life (score 0-4, higher = better) |
Referent | 0.45 (−0.17, 1.07), P = .16 |
| Bladder symptoms score 0-74, higher = worse) |
Referent | −6.68 (−11.8, −1.6), P = .01 |
Limitations
This was a cross-sectional analysis, so pre- vs postoperative comparisons after channel creation could not be performed. Further, not all patient-reported outcome measures assessed have been validated specifically in adolescents and young adults with spina bifida.
Interpretation for Patient Care
Bladder-related quality of life in adolescents and young adults with spina bifida was associated with degree of bladder symptoms, independent of catheterization route. These findings highlight the importance of an individualized bladder management program in spina bifida. What works for one individual may not work for another; there may be multiple methods to achieve the same continence outcome, which will be associated with bladder-related quality of life.
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