Page 4 - CUAJ April 2019: Surveillance urodynamics for neurogenic lower urinary tract dysfunction: A systematic review

Kavanagh et al

Percentage of studies that demonstrate sUDS change in asymptomatic pts 43% of patients had asymptomatic sUDS deterioration (46-5/96) 69% of patients had asymptomatic sUDS deterioration Symptoms not tracked sUDS performed only for symptomatic change 24% of children had asymptomatic UDS deterioration (6/25) Symptoms not tracked Symptoms not tracked; all 37% that required sUDS underwent this for imaging changes Symptoms

New upper urinary tract deterioration None None 1% hydronephrosis, 5% low-grade reflux New hydronephrosis (2%) None UUT deterioration in 80% of patients in observation and 15% of intervention arm 37% of patients had upper urinary tract deterioration 8%, none post- puberty

Superior outcome compared to conservative management No control group No control group No control group No control group No control group Less UUT deterioration in regular sUDS and intervention No control group No control group

Percentage of studies that adjust treatment 47.9% of studies prompt treatment change 96% of patients underwent treatment change 40.6% of patients underwent treatment change Treatment adjusted in 34%; in 10%, treatment changed for symptoms without repeating UDS 32% of patients underwent treatment change 80% of patients in observation and 15% of patients in early intervention required treatment change 37% of pat

Regular or prompted by symptom Regular Regular Regular Symptom-based Symptoms not tracked Regular yearly until toilet- trained, then symptom-based Regular or when imaging revealed upper urinary tract changes Performed for imaging changes or incontinence at school age Regular *Based on patients symptoms or sonographic findings (not regular intervals), CIC: clean intermittent catheterization; DESD: detrosure external sphin

UDS interval (yrs) 1 1 6 Irregular* 1–2 None 1 1 Irregular 1 urinary tract dysfunction; OR: odds ratio; ped: pediatric; SB: spina bifida; SCI: spinal cord injury; sUDS: surveillance urodynamics; UDS: urodynamic study; UUT: upper urinary tract; yrs: years.

FU period (yrs) 2 5 6 6.8 3.83 No control group 9.1 4.5 13 5
Table 3. Surveillance UDS in the setting of NLUTD
Study type/ quality Level 4, cross- sectional Level 4, retrospective cohort series Level 4, retrospective cohort series Level 4, retrospective cohort series Level 4, retrospective cohort series 39% of patients underwent treatment change Level 4, retrospective cohort series Level 2b, retrospective cohort series Level 4, retrospective cohort series Level 4, retrospective cohort series

No. of pts 96 80 246 48 28 ped Regular 25 ped 148 ped 214 ped 37 ped

Pathology SCI SCI SCI SCI SCI SB SB SB SB

Linsenmeyer Nosseir et Schops et Edokpolol et Chao et al 41 Tarcan et al 27 Edelstein et Spindel et Kaufman et Almodhen

Author et al 22 al 23 al 40 al 24 al 29 a l25 al 30 et al 26

136 CUAJ • April 2019 • Volume 13, Issue 4