Page 5 - CUAJ April 2019: Surveillance urodynamics for neurogenic lower urinary tract dysfunction: A systematic review

Surveillance urodynamics for neurogenic lower urinary tract dysfunction

Percentage of studies that demonstrate sUDS change in asymptomatic pts sUDS performed only for symptomatic change OR of any sUDS abnormality given patient symptoms is 0.64 27% of patients had asymptomatic sUDS change Prompted by changing or persistent symptoms Bladder symptoms correlated poorly with any single urodynamic finding Prompted by changing or persistent symptoms Prompted by changing or persistent sympt
increased incontinence
between catheterization,
or alarming features on
ultrasound).
NLUTD management
in pediatric spina bifida
differs from adult pathol-
ogy in the magnitude of
New upper urinary tract deterioration Rarely (2/84) Not tracked None None None None None None UDS evolution in the early
years of life. Spindel et al
25
performed a retrospec -
tive review of 79 pediatric
patients that underwent
Superior outcome compared to conservative management No control group No control group No control group No control group No control group No control group No control group No control group annual sUDS with syner-
gic outlets and biannual
sUDS for dyssynergic out-
lets; 37% of patients had
Percentage of studies that adjust treatment 56% of patients underwent treatment change 25.8% had unsafe bladder requiring treatment change 55% of patients had a change to UDS pattern and all were offered treatment 55% of patients underwent treatment change 30% had changing UDS pattern or imaging change requiring treatment 44% had changing UDS pattern requiring treatment change 36% had changing UDS pattern requ
external urethral sphincter
function over time. There
was a 32% chance of hav-
ing a change in external
sphincter function during
the first 12 months of life,

second 12 months, and a
Regular or prompted by symptom Based on imaging or symptom change Based on imaging or symptom change Symptom-based Symptom-based Symptom-based Symptom-based Symptom-based Single point *Based on patients symptoms or sonographic findings (not regular intervals), CIC: clean intermittent catheterization; DESD: detrosure external sphincter dyssynergia; FU: followup; MS: multiple sclerosis; NLUTD: neurogenic lower a 6% chance during the
2% chance during the third
12 months. Furthermore,
26
Almodhen et al dem-
metric bladder capacity,
UDS interval (yrs) Irregular Irregular 2.9 Irregular Irregular Irregular Irregular Irregular 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. onstrated that total cysto-
maximum detrusor pres-
Table 3 (cont’d). Surveillance UDS in the setting of NLUTD
sure, and detrusor leak
point pressure increase sig-
FU period (yrs) 10.4 10.4 14 2.1 Variable Variable 2.5 2.5 nificantly in patients with
myelomeningocele fol-
lowing puberty on annual
Study type / quality Level 4, retrospective cohort series Level 4, cross- sectional Level 4, retrospective cohort series Level 4, retrospective cohort series Level 4, retrospective cohort series Level 4, retrospective cohort series Level 4, retrospective cohort series Level 4, retrospective cohort series sUDS.
Although several pedi-
atric studies demonstrate
benefit of regular surveil-
No. of pts 84 ped 120 22 18 41 9 33 40 lance 26,27 compared to
28
expectant management,
29
Edelstein et al provided
Pathology SB SB MS MS MS MS MS MS the only prospective con-
trolled study. Authors
compared urological out-
comes of a cohort of chil-
Hopps et al 31 Veenboer et Ciancio et Wheeler et Blaivas et Goldstein et Schoenberg Bemelmans urological deterioration
dren who were at risk for
Author al 17 al 32 al 34 al 36 al 35 et al 33 et al 37 on the basis of bladder-
sphincter dyssynergia

CUAJ • April 2019 • Volume 13, Issue 4 137