INTRODUCTION AND OBJECTIVES: UDS are routinely performed for evaluation and decision making for spina bifida patients (pts). Little data exists to whether UDS findings actually alter clinical impression and change management plans for spina bifida pts beyond what is obtainable by ultrasound. We sought to evaluate the impact of UDS on the change of management.

METHODS: A retrospective analysis of spina bifida pts with neurogenic bladder who underwent UDS in 2006 and 2007 was performed. Pts who did UDS as routine preoperative assessment were excluded. Demographic data and ultrasound findings were recorded. Change in management was defined as alteration of frequency of CIC, dose or frequency of anticholinergics or scheduling surgery.

RESULTS: The study included 133 pts, mean age 9.5 yrs (range 2 months -18 yrs). A change in management based on UDS was identified in 57 pts (42%). Among those 25 (18%) had CIC schedule revision, 53 (39%) had anticholinergic dose adjustment and 12 (9%) had surgery scheduled (7 augmentation cystoplasty, 2 mitrofanoff, 1 sling, 1 botox injection, 1 bladder neck closure). There was no significant difference in age and sex in patients whose management was altered or not. Upper tract status by ultrasound was a significant predictor of change in management. Of pts with normal sonographic upper tracts, 27% had change of management based on UDS findings versus 95% who had change of management when the upper tracts were abnormal (p<0.05).

CONCLUSIONS: Around half of the children with neurogenic bladder will have change of management on follow-up. Although UDS remains to be routinely performed, those with abnormal sonographic upper tracts are more likely to have change of management. UDS may be unnecessary in evaluation of pts with normal upper tracts.

Source of Funding: none