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Introduction: Managing the urinary tract of young adults with
spina bifida (SB) who can no longer manage with clean intermittent catheterization (CIC) presents a unique challenge for urologists. We present our experience with this population from our SB clinic, in which we care for patients from birth to 35 years.
Methods: With IRB approval, we completed a retrospective chart review of SB patients who underwent incontinent urinary diversion in the last 3 years. We collected demographics, preoperative testing, operative characteristics and postoperative events.
Results: We identified six patients who underwent incontinent urinary diversion. Table 1 highlights important patient characteristics, indication for procedure, and complications. The median age at time of surgery was 28.3 years. 5 (83%) patients had significant comorbidities, including hypertension, CKD, severe restrictive lung disease, and sleep apnea. Prior to surgery, all patients had an ultrasound and urodynamics and were evaluated by the complex care service. Median operative time was 313 minutes (range 213-594). The median length of stay was 25 days. 5 (83%) required ICU postoperatively and 4 (67%) had major postoperative complications. At a median of 41.4 months (range 4-67), all patients are dry and renal function is stable or improved.
Conclusions: Incontinent urinary diversion should be considered in young adult SB patients. These patients are complex with high risk of postoperative complications. Clear expectations and goals should be established preoperatively.

Patient	Age (yrs)	Gender	Comorbidities	Guardian	Indication for surgery	Type of procedure	Complication	LOS (days)
1	26	M	Hypertension Chronic Kidney Disease Stage III, Obesity, Shunted hydrocephalus, Mild intellectual disability	Uncle	Worsening renal function, bilateral hydronephrosis, poorly compliant bladder, non-compliance with CIC	Sigmoid Vesicostomy	None	30
2	33	M	Severe restrictive lung disease, Hypertension, Chronic Kidney Disease Stage III, Shunted hydrocephalus, Obstructive sleep apnea	Own	Indwelling suprapubic catheter, incontinence, recurrent urinary tract infections	Ileo- Vesicostomy Cecostomy tube Bladder neck closure	Prolonged intubation, Ileus, Abdominal abscess with shunt infection	57
3	31	F	Shunted hydrocephalus, Obstructive sleep apnea	Own	Indwelling catheter with patulous urethra and incontinence s/p failed sling	Cystectomy L◊R TUU Sigmoid conduit	Prolonged intubation, Urine leak from TUU	22
4	21	M	Hypertension, Severe intellectual disability, Multiple chromosomal anomalies, G-tube dependent	Mother	Worsening renal function, bilateral hydronephrosis, poorly compliant bladder, difficulty maintaining CIC	Ileo- Vesicostomy	Respiratory distress requiring ICU transfer	23
5	24	M	Mild intellectual disability	Foster care	Poorly compliant bladder, non-compliance with CIC	Ileo-Vesicostomy	Small bowel obstruction with surgical intervention	26
6	31	F	Severe restrictive lung disease, Shunted hydrocephalus	Own	Indwelling catheter with patulous urethra and incontinence. h/o gastric augmentation with multiple perforations (5)	Partial cystectomy Ileo-Vesicostomy Bladder neck closure	None	11