Page 3 - CUAJ April 2019: Surveillance urodynamics for neurogenic lower urinary tract dysfunction: A systematic review

Surveillance urodynamics for neurogenic lower urinary tract dysfunction

for intervention was not influenced by
Identification through database search available through other length of time post-injury, or level of
the type of bladder management, the
Additional records
Records identified
sources (n=31)
(n=659)
injury. Only 5.2% of patients reported
new-onset urological symptoms since
their prior annual evaluation.
Duplicates removed
23
(n = 631) Nosseir et al also advised that reli-
ance on clinical symptoms to prompt
Screening Records screened Records excluded sUDS leads to failure to detect a large
number of treatment failures in the
(n=484)
(n=602)
SCI population. The authors reviewed
80 SCI patients with at least one fol-
lowup visit per year for a minimum
of five consecutive years. The focus
Full-text articles
excluded with reasons was to determine how frequently the
treatment regimen had to be modified
Eligibility assessed ‒ Review articles, due to annual sUDS results. Over a
(n=90)
Full-text articles
(n=118)
n=42
‒ Not sUDS-related, mean followup of 67.3 months, the
n =48 treatment strategy had to be modified
in almost all patients. If authors had
relied solely on clinical symptoms or
imaging findings, 68.75% of treatment
Included quantitative synthesis failures would not have been detected.
Articles included in
Conversely, Edokpolol and col-
(n=28)
24
leagues established a safe lower uri-
nary tract with baseline UDS, and
Fig. 1. Flow diagram of search strategy. sUDS: surveillance urodynamics. subsequently performed annual renal
ultrasonography for surveillance. sUDS
SCI was repeated only when patients presented with new symptoms
or alarming radiological changes. Subjects were followed for
Five articles meeting level 4 evidence addressed sUDS in the a mean duration of 6.8 years. sUDS was repeated in 40% of
SCI population (Table 3). Studies included 470 adults and subjects during the study period. After repeat sUDS for new
28 pediatric patients with 2393.4 and 107.3 patient-years onset of symptoms, bladder management was not changed in
of followup, respectively. Four of five articles performed 64% cases. The dose or type of anticholinergic was increased
sUDS based on regularly timed studies defined on a specific or changed in 32% cases, and one subject received bladder
interval (1–2 years) while one article performed surveillance augmentation. In four other subjects, the regimen was modified
based on altered symptoms or imaging findings (recurrent based on symptoms without repeating sUDS. Two new cases of
UTI, increased incontinence between catheterization, or pelvicaliectasis were present at the time of final ultrasound. One
alarming features on ultrasound). case was secondary to an obstructing stone and the second was
The impact of annual sUDS on adjustment of patient treat- due to refractory bladder pressures in a non-compliant patient.
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ment was addressed by Linsemeyer et al. The authors per- The authors concluded that an ultrasound-based surveillance
formed a cross-sectional review of 96 individuals with stable approach is efficacious in SCI patients and suggest that annual
traumatic SCI undergoing annual UDS evaluations. Changes sUDS may be unnecessary.
in the urodynamic parameters and autonomic dysreflexia
were determined by comparing the current study with the Spina bifida
prior year. The main outcome measure was whether or not
there was a need for intervention based on the UDS results. Seven articles meeting level 2b–4 evidence addressed sUDS
Overall, 47.9% of individuals required at least one type of in the spina bifida population (Table 3). Studies included
intervention based on annual UDS: 82.6% were urologi- 120 adult and 587 pediatric patients with 1248 and 5208
cal interventions (medication changes were most common, patient-years of followup, respectively. Five of seven articles
comprising 54.3% of urological interventions); 13.0% were performed sUDS based on regularly timed studies defined
non-urological interventions; and 4.3% were a combination on a specific interval (1–2 years) while two articles per -
of non-urological and urological interventions. The need formed surveillance based on altered symptoms or imaging

CUAJ • April 2019 • Volume 13, Issue 4 135