Impact of untethering of the spinal cord on urological management and antibiotic stewardship among spina bifida patients in Malaysia

doi:10.21203/rs.3.rs-1394466/v2

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Impact of untethering of the spinal cord on urological management and antibiotic stewardship among spina bifida patients in Malaysia

https://doi.org/10.21203/rs.3.rs-1394466/v2

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Background The incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other neurological problems. It occurs in patients with spina bifida and the authors of this study sought to determine the effects of untethering on the urological outcome of children with a tethered cord and thus identifying proper urological management for individuals with spina bifida. Methods Demographic and clinical data were collected via an online questionnaire and convenient sampling technique were used. 49 spina bifida individuals participated in this study. Results The diagnosis of UTIs is dependent on patients reporting cloudy and smelly urine (67%) and urine validation (60%). 18% of the respondents claimed to have been prescribed antibiotics even though they had no history of UTI. Indiscriminate prescription of antibiotics by healthcare workers further compounds the severity of UTI. Employing CISC (73%) including stringent usage of sterile catheters (71%) did not prevent patients from getting UTI. Overall, 33% of our respondents reported manageable control of UTI (0 – 35 years of age). All individuals below the age of 5 (n=14) had improved urological outcome due to the untethering surgery under the guidance of the Malaysia NTD support group. Conclusion Spina biﬁda individuals may procure healthy bladder and bowel continence for the rest of their lives provided that neurosurgical and urological treatment being instigated soon after birth and continuing into adulthood.

spina bifida

urinary tract infection

antibiotic stewardship

Malaysia

Table 1: General characteristics of respondents (n=49)

Description	n (%)
Participants:	43 (88%)
Parents of spina bifida Individuals	43 (88%)
Spina Bifida Individuals	6 (12%)

Gender:
Male	26 (53%)
Female	23 (47%)

Age group:	Male	Female
0-5 years	12 (24%)	7 (14%)
6-20 years	13 (27%)	9 (16%)
21-35 years	1 (2%)	7 (14%)

Table 2: Association of the age of untethering surgery with the impact on the frequency of UTI (n=28)

Variable		Age Group		Chi-square	p-value
		< 5 years n (%)	> 5 years n (%)
Frequency of UTI	No Difference	8 (28.6%)	4 (14.3%)	9.001	0.009*
	Lowered UTI frequency	14 (50.0%)	2 (7.1%)

*Fisher’s Exact Test

Table 3: Impact of completing the untethering surgery on the improvement of kidney function (n=49)

Variable		Done untethering surgery		Chi-square	p-value
		No n (%)	Yes n (%)
Kidney function improved	No	1 (25)	3 (75)	35.285	0.01*
	Yes	-	22 (100)
	Not sure	20 (87)	3 (13)

*Fisher’s Exact Test

Table 4: Impact of completing the untethering surgery on the frequency of UTI (n=49)

Variable		Done untethering surgery		Chi-square	p-value
		No n (%)	Yes n (%)	Chi-square
Impact of untethering surgery on the frequency of UTI?	No difference	17 (34.7)	12 (24.5)	7.209	0.009*
	Lowered UTI frequency	4 (8.2)	16 (32.7)	7.209

*Fisher’s Exact Test

Table 5: Association of different risk factors with the UTI before the untethering surgery (n=45)

Variable		Frequency of UTI			Chi-square	p-value
		No UTI n (%)	Frequent n (%)	Seldom n (%)
Going to a clinic because of UTI	No	11 (55.0)	6 (30.0)	3 (15.0)	8.923	0.033*
	Yes	4 (16.7)	16 (66.7)	4 (16.7)
	Not sure	-	1 (3.3)	-
Asked for testing a urine sample at the clinic	No	11 (55)	6 (30.0)	3 (15.0)	8.923	0.033*
	Yes	4 (16.7)	16 (66.7)	4 (16.7)
	Not sure	-	1 (3.3)	-
Prescribed antibiotics for UTI during clinic visit	No	11 (55)	6 (30.0)	3 (15.0)	8.923	0.033*
	Yes	4 (16.7)	16 (66.7)	4 (16.7)
	Not sure	-	1 (3.3)	-
Going to the hospital because of UTI	No	9 (69.2)	4 (30.8)	-	11.391	0.003
	Yes	6 (18.8)	19 (59.4)	7 (21.9)
Asked for testing a urine sample at the hospital	No	9 (69.2)	4 (30.8)	-	11.391	0.003
	Yes	6 (18.8)	19 (59.4)	7 (21.9)
Prescribed antibiotics for UTI during hospital visit	No	9 (69.2)	4 (30.8)	-	11.391	0.003
	Yes	6 (18.8)	19 (59.4)	7 (21.9)
Validating diagnosis of UTI by a test	No	6 (75.0)	1 (12.5)	1 (12.5)	8.415	0.031*
	Yes	9 (25.0)	21 (58.3)	6 (16.7)
	Not sure	-	1 (100 %)	-
Do you perform clean intermittent self-catheterisation (CISC)	No	5 (45.5)	5 (45.5)	1 (9.1)	3.435	0.514*
	Yes	9 (27.3)	18 (54.5)	6 (18.2)
	Not sure	1 (100)	-	-
Would you consider CISC to be invasive	No	1 (50.0)	1 (50.0)	-	9.215	0.048*
	Yes	6 (19.4)	19 (61.3)	6 (19.4)
	Not sure	8 (66.7)	3 (25.0)	1 (8.3)
Usage of sterile catheter for each use	No	7 (53.8)	3 (23.1)	3 (23.1)	5.926	0.055*
	Yes	8 (25.0)	20 (62.5)	4 (12.5)
Characteristics of urine symptoms	Normal	15 (100.0)	-	-	45.000	0.000
	Smelly & Cloudy urine	-	23 (76.7)	7 (23.3)
Stomach discomfort symptoms	No stomach discomfort	13 (41.9)	12 (38.7)	6 (19.4)	6.135	0.057*
	Stomach discomfort	2 (14.3)	11 (78.6)	1 (7.1)
Back pain symptoms	No back pain	14 (35.9)	18 (46.2)	7 (17.9)	3.060	0.277*
	Back pain	1 (16.7)	5 (83.3)	-
When respondent suspected having UTI	Go to the clinic / hospital	10 (27.0)	21 (56.8)	6 (16.2)	10.943	0.023*
	Take antibiotics (Self-medication)	-	-	1 (100.0)
	Other	7 (71.4)	2 (28.6)	-
Kidney ultrasound	No	4 (26.7)	-	-	8.780	0.018*
	Yes	11 (73.3)	23 (100)	5 (100)

*Fisher’s Exact Test

No competing interests reported.

AdditionalFile1UrologyQuestionnaires.pdf
Additional file 1Title: Survey on Urological Management among Spina Bifida individualsDescription of Data: Questionnaires pertaining to urological management among spina bifida individuals in order to assess the level of understanding of the related disease.

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Impact of untethering of the spinal cord on urological management and antibiotic stewardship among spina bifida patients in Malaysia

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