Presentation Authors: Ruthie Su, Thomas Leffler, Gray Roberge*, Wade Bushman, Madison, WI
Introduction: Cerebral palsy (CP) describes a group of congenital movement disorders caused by a neurologic insult that occurred before or during birth. The urinary problems of the pediatric CP group have been well studied but data is sparse regarding the urologic needs of adults with CP. We present a cohort analysis of CP patients cared for in our university clinic over a 10 year period to better define these challenges and identify opportunities for improved urologic care.
Methods: With IRB approval, we identified patients treated at University of Wisconsin Hospital and Clinics between Jan 1, 2006 and Jan 1, 2017 with infantile cerebral palsy (ICD-9 343, ICD-10 G80). Severity of CP was assessed based on wheelchair dependence, ability to communicate and institutionalization. Urinary symptoms, urologic surgeries, and results from upper tract imaging were extracted from chart review.
Results: Seventy-six patients with CP had an average length of follow-up of 6.1 years. Forty-eight (63%) were male. Forty-one (54%) were non-ambulatory and non-verbal; 40% lived in assisted living. The average initial age for urologic evaluation was 40 years old (range 15-71 years). Eleven patients (14%) died at an average age of 57 years old; the most common reason was aspiration pneumonia. Thirteen patients (17%) had kidney stones of whom 4 required percutaneous cystolithotomy. The most common reasons for urologic consultation were urge/frequency (49%), recurrent UTI (43%), retention or infrequent voiding (42%), and voiding difficulty (33%). At last follow-up, 56% were voiding, 19% relied on CIC, and 16% had an indwelling catheter.
Conclusions: Our review reveals that despite having an early, fixed neurologic insult, many with CP present in mid-adulthood with new onset urinary complaints and nephrolithiasis. They are a heterogeneous and medically complex group of patients whose functional disability and social situations present unique challenges; a deliberate urologic evaluation and partnership with their caregivers both at home and at the skilled facilities is crucial to optimize their management.