Page 1 - CUAJ April 2019: Surveillance urodynamics for neurogenic lower urinary tract dysfunction: A systematic review

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review

Surveillance urodynamics for neurogenic lower This article is CUA-accredited

urinary tract dysfunction: A systematic review for Section 3 credits of the
MOC Program of the RCPSC.
Go to www.cuaj.ca for details.

Alex Kavanagh, MD ; Hamed Akhavizadegan, MD ; Matthias Walter, MD, PhD, FEBU ; Lynn Stothers, MD ;
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Blayne Welk, MD ; Timothy B. Boone, MD 5
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1 Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; Urology Department, Tehran University of Medical Sciences, Tehran, Iran; International Collaboration on Repair
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Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Urology, Western University, London, ON, Canada; Department of Urology, Houston Methodist
Hospital, Houston, TX, United States
Cite as: Can Urol Assoc J 2019;13(4):133-41. http://dx.doi.org/10.5489/cuaj.5563 prognostic value of UDS for maintenance of bladder function
and protection from upper urinary tract (UUT) deterioration
is mentioned in several studies in patients with neurogenic
Published online December 3, 2018 lower urinary tract dysfunction (NLUTD). Surveillance
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urodynamic studies (sUDS) are performed in the ambula-
Abstract tory setting after baseline characterization, with the goal of
maintaining safe lower urinary tract parameters. Although it
Introduction: Baseline urodynamic characterization in patients is well-known that clinical examination alone is not sufficient
with neurogenic lower urinary tract dysfunction (NLUTD) allows to determine individual urological management strategies in
detection of unsafe storage and voiding pressures and optimiza- patients with NLUTD, data demonstrating the value sUDS
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tion of these parameters through medical or surgical intervention. in the setting of NLUTD is lacking. Similarly, optimal fre-
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Surveillance urodynamics (sUDS) studies are performed in the quency of sUDS is unknown. Whether sUDS studies should
ambulatory setting after baseline characterization, with the goal
of monitoring bladder function. How often this study should be be regularly scheduled or performed based on a change to
performed and the circumstances that should prompt repeated stud- patient symptoms is also undetermined.
ies are unknown. The primary objective of this review is to evaluate Clinical practice guidelines suggest regular evaluation for
the evidence supporting sUDS in the setting of NLUTD as assessed patients at high risk of UUT deterioration, but there is a lack
by whether the study leads to 1) change in patient management; 2) of consensus regarding specific risk stratification or frequency
determination of new findings not suggested by imaging or symp- of sUDS evaluation (Table 1). 5-10 Furthermore, there is no con-
toms; and 3) demonstration of superior outcomes compared to sensus if sUDS should be scheduled regularly or repeated for
observation. The secondary objective is to review sUDS practice new patient symptoms or imaging changes. Consequently,
patterns among urologists in their assessment of NLUTD. practice patterns vary with regard to sUDS frequency 11-17 and
Methods: PubMed, EMBASE, and Cochrane Library databases were healthcare utilization data suggests low uptake of sUDS use
reviewed for English-language literature published between January in NLUTD within the U.S. and Canada. 18,19
1975 and March 2018.
Results: Twenty-eight independent articles (1368 patients, 9486 The primary objective of this review was to evaluate the
patient-years of followup) were included. Given heterogeneous evidence supporting sUDS in the setting of NLUTD as assessed
data, 49% of 263 subjects were asymptomatic, yet demonstrated by whether the study leads to 1) change in patient manage-
sUDS abnormality prompting treatment. Eight cross-sectional stud- ment; 2) determination of new urodynamic findings not sug-
ies (four spinal cord injury [SCI], two NLUTD, two spina bifida) gested by either physical examination, imaging change, or
surveyed urologists regarding current sUDS patterns; 53% of 498 patient symptoms; and 3) demonstration of superior outcomes
respondents perform sUDS between one and three years. compared to surveillance without regular UDS. The secondary
Conclusions: Evidence supporting optimal surveillance for NLUTD objective was to review current sUDS practice patterns among
is lacking. Level 2b‒4 evidence suggests that sUDS is likely to urologists in their assessment of NLUTD.
modify patient treatment and often demonstrates findings that
modify treatment in the absence of symptoms or imaging changes.
Methods
Introduction This systematic review was performed according to the
Preferred Reporting Items for Systematic Reviews and Meta-
Baseline urodynamic characterization (UDS) is the gold stan- analysis (PRISMA) statement and registered in PROSPERO
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dard for the evaluation of lower urinary tract dysfunction. The bank of systematic reviews as 76662. We conducted a search

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