Page 8 - CUAJ April 2019: Surveillance urodynamics for neurogenic lower urinary tract dysfunction: A systematic review

Kavanagh et al

What are the current sUDS practice patterns among urologists in their Competing interests: Dr. Kavanagh has participated in advisory board meetings for Paladin Labs
assessment of NLUTD? and has received a research grant from Astellas. Dr. Walter is a Michael Smith Foundation for Health
Research Research Trainee Award recipient, in partnership with the Rick Hansen Foundation (Grant
No. 17110); has received funding from Coloplast, Pfizer, Wellspect, and the Rick Hansen Institute;
The most common self-reported practice pattern of sUDS and has received travel awards from the International Continence Society, American Spinal Injury
in the management of NLUTD is every 1–2 years. Within Association, British Columbia Regenerative Medicine, and Faculty of Medicine at the University of
the U.S. and Canada, healthcare utilization data suggests British Columbia. Dr. Stothers has participated in advisory board meetings for Astellas. Dr. Boone has
that the actual rate of sUDS in the neurogenic population participated in global advisory board meetings and has been a speaker for Astellas. The remaining
ranges from 6.7–10%. The difference between self-reported authors reports no competing personal or financial interests related to this work.
practice patterns and actual use highlights the need for con-
sensus in surveillance standards.
This paper has been peer-reviewed.
Conclusion

Available evidence supporting optimal surveillance proto- References
cols for NLUTD is lacking. Qualitative findings from level
2b–4 evidence suggest that sUDS is likely to modify patient 1. Gerridzen RG, Thijssen AM, Dehoux E. Risk factors for upper tract deterioration in chronic spinal cord injury
treatment, and often leads to new findings not suggested patients. J Urol 1992;147:416-8. https://doi.org/10.1016/S0022-5347(17)37254-3
by physical examination, imaging findings, or new patients 2. McGuire EJ, Woodside JR, Borden TA, et al. Prognostic value of urodynamic testing in myelodysplastic
patients. J Urol 1981;126:205-9. https://doi.org/10.1016/S0022-5347(17)54449-3
symptoms. Establishing a risk-benefit ratio of these findings 3. Wyndaele JJ. Correlation between clinical neurological data and urodynamic function in spinal cord injured
is not possible due to lack of control groups. There is cur- patients. Spinal Cord 1997;35:213-6. https://doi.org/10.1038/sj.sc.3100391
rently no evidence that demonstrates regularly scheduled 4. Bycroft J, Hamid R, Bywater H, et al. Variation in urological practice amongst spinal injuries units in the
sUDS has superior outcome compared to sUDS performed UK and Eire. Neurourol Urodyn 2004;23:252-6; discussion 7. https://doi.org/10.1002/nau.20005
for symptom or imaging change. 5. Blok B, Pannek J, Castro-Diaz D, et al . EAU guidelines on neuro-urology, 2016. Available at:
https://uroweb.org/wp-content/uploads/EAU-Guidelines-Neuro-urology-2016-1.pdf. Accessed Feb. 12, 2019.
The most common practice pattern of surveyed urologists 6. Stohrer M, Blok B, Castro-Diaz D, et al. EAU guidelines on neurogenic lower urinary tract dysfunction. Eur
was to repeat sUDS every 1–2 years. Review of currently Urol 2009;56:81-8. https://doi.org/10.1016/j.eururo.2009.04.028
available guidelines (Table 1) demonstrated two conventional 7. Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in
approaches for UDS. The primary approach is to stratify into Neurological Disease. National Institute for Health and Clinical Excellence: Guidance. London2012.
risk groups with baseline UDS. Low-risk groups are those 8. Collins CW, Winters JC. AUA/SUFU adult urodynamics guideline: A clinical review. Urol Clin North Am
2014;41:353-62. https://doi.org/10.1016/j.ucl.2014.04.011
that have safe storage parameters, including high capacity, 9. Abrams P, Agarwal M, Drake M, et al. A proposed guideline for the urological management of patients with
high compliance, and low storage pressure. High-risk groups spinal cord injury. BJU Int 2008;101:989-94. https://doi.org/10.1111/j.1464-410X.2008.07457.x
include parameters that place UUT at risk, including detrusor- 10. Consortium for Spinal Cord Medicine. Bladder management for adults with spinal cord injury: A clinical
sphincter dyssynergia with sustained raised vesicle pressure or practice guideline for health-care providers. J Spinal Cord Med 2006;29:527-73.
low compliance, before and after a change in bladder man- 11. Al Taweel W, Alkhayal A. Neurogenic bladder evaluation and management after spinal cord
injury: Current practice among urologists working in Saudi Arabia. Urol Ann 2011;3:24-8.
agement; onset of UTIs or urinary tract stones; or presence of https://doi.org/10.4103/0974-7796.75872
VUR or high post-void residual. sUDS is typically reduced in 12. Blok BF, Karsenty G, Corcos J. Urological surveillance and management of patients with neurogenic bladder:
the former to a lengthy interval (although no consensus exists Results of a survey among practicing urologists in Canada. Can J Urol 2006;13:3239-43.
to define this interval). The latter group is typically investi- 13. Elliott SP, Villar R, Duncan B. Bacteriuria management and urological evaluation of patients with spina bifida
gated and followed at a more closely defined and regimented and neurogenic bladder: A multicentre survey. J Urol 2005;173:217-20. https://doi.org/10.1097/01.
ju.0000146551.87110.f4
schedule, such as regular sUDS every 1–2 years. 14. Kitahara S, Iwatsubo E, Yasuda K, et al. Practice patterns of Japanese physicians in urologic surveillance
An alternative to this approach is to establish a baseline and management of spinal cord injury patients. Spinal Cord 2006;44:362-8. https://doi.org/10.1038/
with UDS followed by on-demand sUDS if patient presenta- sj.sc.3101854
tion evolves during the course of followup. Findings such 15. Razdan S, Leboeuf L, Meinbach DS, et al. Current practice patterns in the urologic surveillance and
as new-onset hydronephrosis, reflux, deterioration in renal management of patients with spinal cord injury. Urology 2003;61:893-6. https://doi.org/10.1016/
S0090-4295(02)02518-9
function, increased infection frequency, or urinary calculi 16. Rikken B, Blok BF. Management of neurogenic bladder patients in The Netherlands: Do urologists follow
formation prompt sUDS evaluation. guidelines? Neurourol Urodyn 2008;27:758-62. https://doi.org/10.1002/nau.20582
The optimal sUDS strategy in surveillance of NLUTD has 17. Veenboer PW, Ruud Bosch JL, de Kort LM. Assessment of bladder and kidney functioning in
not yet been established and will likely require further data adult spina bifida patients by Dutch urologists: A survey. Neurourol Urodyn 2014;33:289-95.
https://doi.org/10.1002/nau.22413
to establish a validated protocol. This review demonstrated 18. Cameron AP, Lai J, Saigal CS, et al; Project NUDiA. Urological surveillance and medical complications
that existing literature is limited by small enrollment stud- after spinal cord injury in the United States. Urology 2015;86:506-10. https://doi.org/10.1016/j.
ies with heterogeneous populations completed over a time urology.2015.06.005
course that is extensive. There is clearly a need for further 19. Welk B, Liu K, Shariff SZ. The use of urologic investigations among patients with traumatic spinal cord
high-quality studies to determine the optimal surveillance injuries. Res Rep Urol 2016;8:27-34. https://doi.org/10.2147/RRU.S99840
strategy of UDS with NLUTD.

140 CUAJ • April 2019 • Volume 13, Issue 4