Urologic Manifestations of Uterine Leiomyomata in Women with Spina Bifida.

OBJECTIVE: To examine our experience with presentation and management of uterine leiomyomata (fibroids) in women with spina bifida (SB). Advances in health care have dramatically improved the life expectancy for individuals living with SB, but they face unique health challenges surrounding reproductive health. Uterine leiomyomata have not previously been described in this population. We hypothesize that their course is likely complicated by SB-specific disabilities and prior surgeries. METHODS: We queried our institutional database for adults with SB and a diagnosis of uterine leiomyomata and/or history of hysterectomy. Clinical data were abstracted from patient records. RESULTS: Five individuals were identified who required management of leiomyomata, representing 2.4% of adult women in our SB clinic. All had lumbar myelomeningocele, hydrocephalus (managed by ventriculoperitoneal shunt), and neurogenic bladder. Three had histories of sexual activity, and 1 had given birth. Two presented with increased urinary frequency/incontinence, and 2 presented with abdominal/pelvic pain. Four underwent hysterectomy with the urology team present to prevent/repair injury to the urinary tract, which had been reconstructed in 2. Mean age of menarche, presentation, and hysterectomy were 10.8, 39.8, and 42.5 years, respectively. One developed upper tract dilation due to compression, which resolved after hysterectomy. CONCLUSION: Adult women living with SB face unique considerations and now live long enough to develop leiomyomata. When symptomatic, surgical management is often needed and may require urologic collaboration. Special care should be taken to protect the bladder and ureters, particularly with a history of prior bladder reconstructive surgery, as well as ventriculoperitoneal shunt, if present.

Duke Scholars

Author Alexandria Spellman  

Author John Samuel Wiener Urology