title: Urological Follow-up in Adult Spina Bifida Patients: Is There an Ideal Interval?
abstract: To establish the time to development of urological issues over time in adult spina bifida (SB) patients.
  
  
  
  This is a retrospective study of adult patients attending a multidisciplinary adult SB clinic from 2000 to 2013. Patient age, sex, number of clinic visits, and length of follow-up were recorded. For each unique visit, presence of symptoms, type of urological issue (if any), and time lapsed since last appointment were obtained. The interval between the development of urological issues was assessed using a time-to-event analysis.
  
  
  
  One hundred twenty-three patients (46% male, 54% female, median age 26.8years) were followed for a median of 48 months, contributing to 586 unique clinic visits. Urological issues were identified in 109 patients (88.5%) during 267 visits (46%), and of those 21% were asymptomatic. In symptomatic patients, the median time to present with a urological issue was 12 months. Among the asymptomatic cases, 12%, 23%, and 34% had developed a urological issue at 12, 24, and 36 months of follow-up, respectively. Eighty-one percent of the urological issues seen in the clinic required some form of treatment or intervention. The treatment or intervention in 56% of asymptomatic urological issues was surgery.
  
  
  
  Most adult SB patients with urological issues are symptomatic by 2 years of follow-up; however, over time the proportion of asymptomatic patients with urological issues rises steadily, reaching a worrisome 34% at 3 years. Closer follow-up seems warranted.
authors.affiliation: Department of Urology, Dalhousie University, Halifax, NS, Canada.
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Duplisea
authors.affiliation: Department of Urology, Dalhousie University, Halifax, NS, Canada; Division of Pediatric Urology, IWK Health Centre, Halifax, NS, Canada. Electronic address: rodrigo.romao@dal.ca.
authors.forename: Rodrigo L P
authors.initials: RL
authors.lastname: Romao
authors.affiliation: Department of Urology, Dalhousie University, Halifax, NS, Canada; Division of Pediatric Urology, IWK Health Centre, Halifax, NS, Canada.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: MacLellan
authors.affiliation: Department of Urology, Dalhousie University, Halifax, NS, Canada.
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Cox
authors.affiliation: Department of Urology, Dalhousie University, Halifax, NS, Canada; Division of Pediatric Urology, IWK Health Centre, Halifax, NS, Canada.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications*; D063189:Symptom Assessment; D013997:Time Factors; D014570:Urologic Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D055815:Young Adult