Page 2 - CUAJ April 2019: Surveillance urodynamics for neurogenic lower urinary tract dysfunction: A systematic review

Kavanagh et al

Table 1. Surveillance urodynamic guideline statements
Guideline Population UDS surveillance suggestion
European Association of Urology NLUTD Urodynamic investigation is a mandatory baseline diagnostic and in high-risk
guidelines on neuro-urology 2013, 2016 5,6 patients, should be done at regular intervals
NICE guidelines. Urinary incontinence in NLUTD Consider urodynamic investigations as part of a surveillance regimen for people
neurological disease: Assessment and at high risk of upper urinary tract complications (for example, people with spina
management, 2012 7 bifida, spinal cord injury, or anorectal abnormalities)
Adult urodynamics: AUA/SUFU NLUTD Clinicians should perform a cystometrogram (CMG) during initial urological
guideline, 2012 8 evaluation of patients with relevant neurological conditions with or without
symptoms and as part of ongoing followup when appropriate
Consortium for Spinal Cord Medicine. SCI Generally, a urological evaluation is done every year, although there is no
Bladder management for adults with consensus among doctors on the frequency this type of exam should be performed
spinal cord injury: A clinical practice or the range of tests that should be included
guideline for healthcare providers, 2006 10
A proposed guideline for the urological SCI Urodynamics are recommended when: upper urinary tract safety is an issue; recent
management of patients with spinal cord onset incontinence has occurred; previous urodynamics showed detrusor-sphincter
injury. UK guideline, 2007 9 dyssynergia with sustained raised vesicle pressure or low compliance; before
and after a change in bladder management; onset of UTIs or urinary tract stones;
presence of VUR; high PVR
AUA: American Urological Association; NICE: National Institute for Health and Care Excellence; NLUTD: neurogenic lower urinary tract dysfunction; PVR: post-void residual; SCI: spinal cord
injury; SUFU: Society for Urodynamics and Female Urology; UTI: urinary tract infection; VUR: vesicoureteral reflux.
of the PubMed, EMBASE, and Cochrane Library databases specific interval (1–2 years) in nine studies and based on
for English-language literature published between January altered symptoms or imaging findings (recurrent urinary tract
1975 and March 2018. Medical subject heading (MeSH) infection [UTI], increased incontinence between catheter-
terms included: 1) neurogenic lower urinary tract dysfunc- ization, or alarming features on ultrasound) in nine articles
tion; 2) neurogenic bladder; and 3) urodynamic(s). Each of (predominantly MS). Individual findings for SCI, spina bifida,
these terms was crossed with: 1) long-term care; 2) long-term and MS patients are provided in the following sections.
surveillance; and 3) long-term followup (Table 2). Only stud-
ies related to NLUTD and urological followup were included
in this review article. Studies were also identified by hand
search of reference lists and review articles.
Studies were included if they presented: 1) findings relat-
ed to one of the four previously mentioned inquiries; 2) Table 2. MeSH permutations used
pediatric or adult data relating to sUDS; 3) published since Search term Concepts
1975; and 4) written in English. sUDS was defined as ≥2 Neurogenic bladder Neurogenic and Bladder [ Keywords]
or
studies performed after baseline UDS characterization. We Neurogenic lower urinary Neurogenic and lower and urinary
tract dysfunction
excluded review articles and studies not available in full- and tract and dysfunction
text format (Fig. 1). All articles were graded according to the and
Oxford Centre for Evidence-based Medicine guidelines. 21 Urodynamics Urodynamic (Urodynamics,
Urodynamic study, Urodynamic
Results evaluation)
and
Initial records identified through database search included Long-term care Long-term and care
659 articles; 31 additional records were identified through Long-term surveillance or
other sources. The study selection procedure is described Long-term followup Long-term and Surveillance
or
in Fig. 1. During the data extraction process, articles were Long-term and Followup
excluded if the detailed full review revealed that they did or
not meet the initial criteria and articles were added from the Hydronephrosis Hydronephrosis
referenced bibliographies if they met the inclusion criteria. Vesicoureteral reflux or
At the end of this full review, 28 of the 690 articles met our End-stage renal disease Vesicoureteral and reflux
final criteria (Tables 3, 4). Chronic kidney or
All reviewed articles focused on NLUTD secondary to insufficiency End-stage and renal and disease
or
Chronic kidney
either spinal cord injury (SCI), multiple sclerosis (MS), or spina insufficiency Chronic and kidney and insufficiency
bifida. Results could not be combined due to heterogeneity or
of underlying pathology. sUDS was performed on a regular, Chronic and kidney and insufficiency

134 CUAJ • April 2019 • Volume 13, Issue 4