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Hobbs C, Howles S, Derry F, Reynard J. Suprapubic Catheterisation ‐ A study of 1000 elective procedures. BJU Int 2022; 129:760-767. [DOI: 10.1111/bju.15727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/11/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Catherine Hobbs
- Churchill Hospital Oxford University NHS Foundation Trust England
| | - Sarah Howles
- Churchill Hospital Oxford University NHS Foundation Trust England
| | - Fadel Derry
- National Spinal Injuries Centre, Stoke Mandeville Hospital Buckinghamshire Healthcare NHS Trust England
| | - John Reynard
- Churchill Hospital Oxford University NHS Foundation Trust England
- National Spinal Injuries Centre, Stoke Mandeville Hospital Buckinghamshire Healthcare NHS Trust England
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Evaluation and management of neurogenic bladder after spinal cord injury: Current practice among physical medicine and rehabilitation specialists in Turkey. Turk J Phys Med Rehabil 2021; 67:225-232. [PMID: 34396074 PMCID: PMC8343156 DOI: 10.5606/tftrd.2021.5817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/24/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to determine the current trends in evaluation and management of neurogenic bladder secondary to spinal cord injury (SCI) among Physical Medicine and Rehabilitation (PMR) specialists in Turkey. Materials and methods Between September 2013 and November 2013, a total of 100 PMR specialists from 18 different provinces of Turkey were included in the study. A 23-item questionnaire was developed to evaluate the current practice on assessment and follow-up of upper and lower urinary tract dysfunction. The questionnaire was delivered via e-mail to the participants routinely providing care for patients with SCI and all responses were obtained electronically. Results For surveillance of the upper urinary tract dysfunction, 93% of the participants preferred ultrasonography. A total of 59% of the participants favored an annual assessment and 36% preferred six-month intervals. Multichannel urodynamics, voiding cystourethrography combined with urodynamics, and video-urodynamics were preferred by 62%, 25%, and 10% of the participants, respectively for surveillance of the lower urinary tract. Urodynamic evaluation was performed annually by 51% of the participants. In patients with detrusor overactivity unresponsive to the combination of intermittent catheterization (IC) and anticholinergic agents, 66% preferred to increase the dose and 22% preferred to switch to another medication. For treatment of areflexic bladder, 78% preferred IC and 12% preferred the Credé' or Valsalva maneuvers. Treatment of asymptomatic bacteriuria was not favored in patients on IC and indwelling urethral catheter by 33% and 44% of the participants respectively. Totally, 84% participants preferred to administer antibiotics for 10 to 14 days for the treatment of symptomatic urinary tract infection. Conclusion Our study results indicate that there are some differences in the current practice of PMR specialists for surveillance and management of SCI patients with neurogenic bladder. These results also emphasize the need for development of guidelines and implementation of continuous medical education activities in this field.
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Barriers and facilitators to optimising inpatient bladder management after spinal cord injury. Spinal Cord 2020; 58:1291-1300. [PMID: 32457515 DOI: 10.1038/s41393-020-0487-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Qualitative survey. OBJECTIVES Examine clinicians' perspectives on adherence to published evidence-based guidelines and clinician-perceived barriers, and facilitators to optimising inpatient bladder management within one Spinal Cord Injury (SCI) service. SETTING Surgical Hospital (acute care) and SCI Unit (sub-acute, rehabilitation) in Western Australia (WA). METHODS Clinicians reviewed an 'Evidence Matrix' summarising published clinical practice guidelines and recommendations for SCI bladder management. Focus groups examined the extent to which current practice adhered to recommendations and identified perceived barriers and facilitators to optimal management. Data were analysed thematically using a deductive approach. RESULTS Current management closely mirrors published recommendations. Key facilitators included long-standing prioritisation of rapid progression from urethral indwelling (IDC) to a 6 hourly intermittent catheterisation (IC) protocol; regular competency audits of catheterisation technique; and a Spinal Urology Clinical Nurse Consultant (CNC) position. Barriers included limited resources/staffing; restricted access to Neuro-urology consultation; inter-disciplinary communication gaps; and delays in determining and implementing long-term bladder management. CONCLUSIONS Inpatient SCI bladder care in WA closely emulates published evidence, although adherence at other sites may reveal different practices. Bladder management was found to have been facilitated by a strong culture of practice led by Neuro-urologists, informed by evidence and embraced by Senior Clinicians. Further reduction in duration of initial IDC, provision of early and ongoing Neuro-urology consultations as part of standard care, increased interdisciplinary communication and dedicated SCI Urology theatre lists would further optimise management.
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Kavanagh A, Akhavizadegan H, Walter M, Stothers L, Welk B, Boone TB. Surveillance urodynamics for neurogenic lower urinary tract dysfunction: A systematic review. Can Urol Assoc J 2019; 13:133-141. [PMID: 30526805 PMCID: PMC6456346 DOI: 10.5489/cuaj.5563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Baseline urodynamic characterization in patients with neurogenic lower urinary tract dysfunction (NLUTD) allows detection of unsafe storage and voiding pressures and optimization of these parameters through medical or surgical intervention. Surveillance urodynamics (sUDS) studies are performed in the ambulatory setting after baseline characterization, with the goal of monitoring bladder function. How often this study should be performed and the circumstances that should prompt repeated studies are unknown. The primary objective of this review is to evaluate the evidence supporting sUDS in the setting of NLUTD as assessed by whether the study leads to 1) change in patient management; 2) determination of new findings not suggested by imaging or symptoms; and 3) demonstration of superior outcomes compared to observation. The secondary objective is to review sUDS practice patterns among urologists in their assessment of NLUTD. METHODS PubMed, EMBASE, and Cochrane Library databases were reviewed for English-language literature published between January 1975 and March 2018. RESULTS Twenty-eight independent articles (1368 patients, 9486 patient-years of followup) were included. Given heterogeneous data, 49% of 263 subjects were asymptomatic, yet demonstrated sUDS abnormality prompting treatment. Eight cross-sectional studies (four spinal cord injury [SCI], two NLUTD, two spina bifida) surveyed urologists regarding current sUDS patterns; 53% of 498 respondents perform sUDS between one and three years. CONCLUSIONS Evidence supporting optimal surveillance for NLUTD is lacking. Level 2b-4 evidence suggests that sUDS is likely to modify patient treatment and often demonstrates findings that modify treatment in the absence of symptoms or imaging changes.
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Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hamed Akhavizadegan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Urology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- Division of Urology, Western University, London, ON, Canada
| | - Timothy B. Boone
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
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Przydacz M, Chlosta P, Corcos J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int Urol Nephrol 2018; 50:1005-1016. [PMID: 29569211 DOI: 10.1007/s11255-018-1852-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/19/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To review currently available guidelines and recommendations regarding urological follow-up of patients after spinal cord injury (SCI) and present an evidence-based summary to support clinicians in their clinical practice. METHODS Maximum data were collected according to different methods, including searches with multiple and specific keywords, reference checks, gray literature searches (congress reports, working papers, statement documents), and browsing-related Web site access. Obtained data were analyzed with the modified version of the Oxford grading system for recommendations using levels of evidence (LE) and grades of recommendation (GR). RESULTS Different surveillance strategies exist, but there is no consensus among authors and organizations. As a result, practice patterns vary around the world. The present review indicates that proper urological follow-up of SCI patients should consist of medical history (LE 1-4, GR B-C), clinical examination (LE 4, GR C), renal laboratory tests (LE 1-3, GR B), imaging surveillance of the upper urinary tract (LE 1-3, GR A-B), urodynamic study (LE 2-4, GR B-C), and cystoscopy/cytology (LE 1-4, GR D). Clinicians agree that SCI patients should be followed up regularly with an individually tailored approach. A 1-year follow-up schedule seems reasonable in SCI patients without additional risk factors of renal deterioration (LE 3-4, GR C). In those who manifest risk factors, report changes in bladder behavior, or present with already developed complications of neurogenic bladder dysfunction, follow-up plans should be modified with more frequent checkups (LE 4, GR C). Urodynamic study should be repeated and considered as a routine monitoring strategy. CONCLUSION Individuals with neurogenic lower urinary tract dysfunction are at increased risk of multiple complications. Nevertheless, proper follow-up after SCI improves the prognosis for these patients and their quality of life.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Urology, Jagiellonian University, Medical College, Kraków, Poland
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University, Medical College, Kraków, Poland
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada.
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Alimi Q, Hascoet J, Manunta A, Kammerer-Jacquet SF, Verhoest G, Brochard C, Freton L, Kerdraon J, Senal N, Siproudhis L, Rioux-Leclercq N, Brucker B, Gamé X, Peyronnet B. Reliability of urinary cytology and cystoscopy for the screening and diagnosis of bladder cancer in patients with neurogenic bladder: A systematic review. Neurourol Urodyn 2017; 37:916-925. [DOI: 10.1002/nau.23395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/05/2017] [Indexed: 11/07/2022]
Affiliation(s)
| | - Juliette Hascoet
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
| | - Andrea Manunta
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
| | | | | | - Charlène Brochard
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Gastro-Entérologie; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | | | - Jacques Kerdraon
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de médecine physique et réadaptation; CHU Rennes; Rennes France
- Centre de rééducation de Kerpape; Ploemeur France
| | - Nelly Senal
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de médecine physique et réadaptation; CHU Rennes; Rennes France
| | - Laurent Siproudhis
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Gastro-Entérologie; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | | | - Benjamin Brucker
- New York Langone Medical Center; NYU Urology Associates; New York New York
| | - Xavier Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Benoit Peyronnet
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
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Wyndaele JJ, Vodušek DB. Approach to the male patient with lower urinary tract dysfunction. NEUROLOGY OF SEXUAL AND BLADDER DISORDERS 2015; 130:143-64. [DOI: 10.1016/b978-0-444-63247-0.00009-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Bladder cancer in individuals with spinal cord injuries. Spinal Cord 2013; 51:516-21. [PMID: 23608811 DOI: 10.1038/sc.2013.33] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 02/20/2013] [Accepted: 03/21/2013] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Prospective scoping review. OBJECTIVES To conduct a scoping review of all the literature related to bladder cancer in individuals with spinal cord injuries (SCI). METHODS Literature search of the databases Pubmed, CINAHL, ProQuest, PsychINFO and Scopus up to and including August 2012. Articles related to bladder cancer among SCI patients were identified, and data pertaining to epidemiology, risk factors, screening, prevention and management was reviewed and summarized. RESULTS An association between bladder cancer and SCI was first reported in the 1960s, with some case reports suggesting an alarmingly high rate among SCI patients. More recent epidemiological studies have reported this risk to be substantially lower. However, bladder cancer in SCI patients tends to present at an earlier age and at a more advanced pathological stage than bladder cancer in the general population. Presenting symptoms may be atypical, and early recognition is important to improve prognosis with surgical resection. Several risk factors have been identified, including indwelling catheters, urinary tract infections and bladder calculi. Screening of SCI patients for bladder cancer is routinely recommended in many SCI management guidelines and by expert consensus; however, evidence for screening tools and protocols is lacking. CONCLUSION Bladder cancer is a rare, and potentially lethal occurrence in SCI patients. Physicians need to have a high index of suspicion for bladder cancer, particularly among SCI patients managed with long-term indwelling catheters.
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Veenboer PW, Ruud Bosch J, de Kort LM. Assessment of bladder and kidney functioning in adult spina bifida patients by Dutch urologists: A survey. Neurourol Urodyn 2013; 33:289-95. [DOI: 10.1002/nau.22413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/20/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Paul W. Veenboer
- Department of Urology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - J.L.H. Ruud Bosch
- Department of Urology; University Medical Centre Utrecht; Utrecht The Netherlands
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Denys P, Soler JM, Fatton B, Rischmann P, Yelnik A, Aegerter P, Saidji-Domingo NY, Chartier-Kastler E. Mise en évidence des différences de gestion des vessies neurologiques existantes entre urologues et médecins spécialisés en médecine physique et de réhabilitation : enquête réalisée auprès de 383 spécialistes. Presse Med 2012; 41:e599-608. [DOI: 10.1016/j.lpm.2011.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 09/07/2011] [Accepted: 09/21/2011] [Indexed: 11/30/2022] Open
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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. [PMID: 21346829 PMCID: PMC3036996 DOI: 10.4103/0974-7796.75872] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 12/01/2010] [Indexed: 11/24/2022] Open
Abstract
AIM The aim of this study is to determine the current trends in the management and surveillance of the NB population secondary to spinal cord injury (SCI) or myelomeningocele by certified urologist working in Saudi Arabia and to compare it to the current guidelines. MATERIALS AND METHODS A cross-sectional study was conducted using a 12-points questionnaire distributed to urologists working in Saudi Arabia and registered at the Saudi medical association. The assessment and follow-up of upper and lower urinary tract function in neurogenic bladder patients, their optimal frequency and management of related infections were the topics of inquiry. RESULTS Of the 272 urologists surveyed, 105 responded, yielding a response rate of 38%. Eighty-nine percent of respondents said that ultrasound was their diagnostic tool of choice for upper tract evaluation. Sixty-one percent of respondents said that they would follow their patients with a multichannel urodynamic study. Forty percent of urologists stated that they would treat asymptomatic bacteriuria. Clean intermittent catheterization (CIC) was the most common modality chosen for the management of neurogenic bladder in patients with emptying difficulties. CONCLUSION This study confirms that most urologists in Saudi Arabia involved with neurogenic bladder management. However, more than one third of the urologists do not have urodynamic machine and only two of the reporting practitioners has a videourodynamic machine. The results emphasize the need for clear guidelines in this field of urology in Saudi Arabia. Highly specialized rehabilitation centers for neurogenic bladder secondary to SCI are required for optimal care and urologist teaching.
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Affiliation(s)
- Waleed Al Taweel
- King Faisal Specialist Hospital and Research Center, Alfaisal University and Saud Bin Abdulaziz University, Riyadh, Saudi Arabia
| | - Abdullah Alkhayal
- King Faisal Specialist Hospital and Research Center, Alfaisal University and Saud Bin Abdulaziz University, Riyadh, Saudi Arabia
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Abstract
STUDY DESIGN Retrospective review. OBJECTIVE Spinal cord injury is a known risk factor for bladder cancer. The risk of bladder cancer has been reported at 16-28 times higher than the general population. Earlier studies have identified indwelling catheters as risk factors. We examined the characteristics of bladder cancers in a spinal cord injury (SCI) population. SETTING Long Beach VA Hospital Spinal Cord Injury Unit, Long Beach, California. METHODS We reviewed SCI patients seen and diagnosed with bladder tumors between January 1983 and January 2007. Data collected included time since diagnosis, method of diagnosis, form of bladder management, pathologic type, treatment of the tumor, and outcome. RESULTS A total of 32 patients with bladder cancer were identified out of 1319 seen. Tumors found were 46.9% squamous cell carcinoma (SCC), 31.3% transitional cell carcinoma (TCC), 9.4% adenocarcinoma, and 12.5% mixed TCC and SCC. The primary form of bladder management was 44% urethral catheter for a mean of 33.3 years, 48% external catheter for a mean of 37.4 years, and 8% intermittent catheterization for a mean of 24.5 years. Nineteen patients had a known method of cancer detection with 42% found on screening cystoscopy. CONCLUSIONS The pathologic makeup of the tumors is similar to that reported earlier. Over 50% of patients diagnosed with bladder cancer in our population did not have an indwelling catheter. This suggests that the neurogenic bladder, not the indwelling catheter, may be the risk factor for bladder cancer. Urologists should consider diligent, long-term screening of all patients with SCI for bladder cancer and not just those with indwelling catheters.
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Rikken B, Blok BFM. Management of neurogenic bladder patients in The Netherlands: do urologists follow guidelines? Neurourol Urodyn 2009; 27:758-62. [PMID: 18508332 DOI: 10.1002/nau.20582] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS Preventive measurements are obligatory for optimal treatment of neurogenic bladder patients. We investigated Dutch urological practice in neurogenic bladder patients in relation to the available guidelines on neurogenic bladder. METHODS A 12-point survey was sent to all 304 certified urologists of the Dutch Urological Association in July 2007. Management of urinary tract infections (UTI), follow-up of the lower and upper urinary tract and treatment techniques were topics of inquiry. RESULTS The response rate was 46% of which 94% were involved in treatment of neurogenic bladder patients. Follow-up was performed every 6 or 12 months in 86%, urine analysis respectively in 85% and upper urinary tract imaging with ultrasound in 60%; only 12% routinely repeated urodynamics. Uncomplicated UTI was treated for 7.1 days in women and 9.2 days in males. Eighteen percent used the EAU guidelines on neurogenic bladder frequently, 35% did occasionally and 47% did not use them at all. Urologists, that used these guidelines frequently, treated asymptomatic UTIs significantly less frequent in patients on intermittent catheterization (5% vs. 25%; P = 0.008); no difference was found in frequency of follow-up, urine analysis, surveillance of upper urinary tract, use of routine urodynamics, and availability of treatment techniques. Video urodynamics, the golden standard, was used by only 11% of the adult urologists. CONCLUSION The majority of Dutch urologists is involved in the treatment of neurogenic bladder, which suggests a less prominent role for specialized centers. Furthermore, urodynamics are not performed routinely. These observations are contrary to the recommendations of the available guidelines.
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Affiliation(s)
- Berend Rikken
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
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