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Comprehensive Care for Patients with Spina Bifida

The Division of Pediatric Urology at MUSC Children’s Hospital has established itself as a regional center for the comprehensive treatment of patients with spina bifida. These children are best cared for at regional centers by a team of specialists and pediatric surgeons experienced in the management of patients with congenital defects. That depth of experience is now available at MUSC with the recruitment over the past few years of three fellowship-trained pediatric urologists, Andrew A. Stec, M.D., Todd Purves, M.D., PhD, and Michaella Prasad, M.D.

Children with spina bifida are born with a spinal canal defect or an opening through which a portion of the spinal cord sometimes protrudes. A wide spectrum of neurological disorders can result, from gait abnormalities to poorly developed limbs to difficulties voiding and poor bladder function. Surgery is needed within days of birth to close the spinal cord; however, that surgery does not resolve all of the neurological issues.

These children often require a comprehensive bladder and bowel management program to assist with continence as well as optimize the child’s kidney, bladder, and bowel health. This includes periodic urodynamic monitoring during both infancy and development, as well as annual ultrasounds and check-ups to help optimize the child’s genitourinary health. In children born with spina bifida, poor bladder function can lead to the transmission of pressure to the kidney, causing kidney infection, damage, and scarring. MUSC’s new urodynamics suite, directed by Dr. Purves and Kate Mack, DNP, FNP, APRN, offers these patients the intensive urodynamic monitoring they need in a child-friendly environment.

For patients who are found to have persistent troubles with voiding and defecation, further procedures may be necessary. Catheterization or a surgery to facilitate bladder emptying can solve voiding issues for some patients, while others may require reconstructive surgery of the sphincter to provide the resistance necessary for proper emptying of the bladder. Children with chronic constipation that has proven resistant to enemas or medications may require the creation of a stoma to their colon through which they can flush saline to prompt a bowel movement.

Because of the close bladder and bowel management required in many of these children to ensure voiding, improve continence, and prevent chronic constipation, MUSC’s pediatric urologists assume almost a primary care role for these patients. They develop an intimate knowledge of each child’s challenges and tailor a management plan that addresses those needs and delivers the best quality of life possible for these children. According to Dr. Stec, "MUSC has setup a state-of-the-art spina bifida center to care for children from throughout the state of South Carolina as well as to assist with complex and difficult cases referred from throughout the southeastern region.”