Follow‐up of the neuro‐urological patient: a systematic review

Abstract

ObjectivesTo systematically review the long-term urological follow-up strategies for patients with neurogenic lower urinary tract dysfunction (NLUTD), focusing on three main groups of neurological diseases: (i) spinal cord injuries, (ii) spinal dysraphism, and (iii) multiple sclerosis. Patients and MethodsData acquisition comprised electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE) database and the EMBASE database in August 2014 to retrieve English language studies. MEDLINE and EMBASE search included the following medical subject heading (MeSH) terms: (i) neurogenic bladder and (ii) neurogenic bladder dysfunction. Each of these terms was crossed with (i) long-term care and (ii) long-term surveillance. Only studies related to NLUTD and urological follow-up were included. Studies were also identified by hand search of reference lists and review articles. ResultsInitial records identified through database searching included 265 articles. In all, 23 articles were included in the quantitative synthesis. The proposed time schedule of investigations as well as the amount and type of investigation were different according to specific neurological lesions. They depend on the dysfunctional pattern of the lower urinary tract (LUT) and its risk profile. However, there is a lack of high-evidence level studies to support an optimal long-term follow-up protocol. ConclusionsThe goal of neuro-urological management is the best possible preservation of upper urinary tract (UUT) and LUT function in relation to the individual neurological disorder. Regular and risk adapted controls ('urochecks') allow detection of risk-factors in time before irreversible changes of the LUT and UUT have occurred. With risk-and patient-oriented lifelong regular urological care an optimised quality of life and life-expectancy can be achieved, although there is a complete lack of high-evidence level studies on this topic.

Bladder emptying method is the primary determinant of urinary tract infections in patients with spinal cord injury: results from a prospective rehabilitation cohort study

“…Studies that reported lower cumulative UTI IRs tended to use more restrictive definitions for UTIs, such as the presence of a fever in addition to a positive bacterial culture or a higher threshold for a positive bacterial culture . Swiss rehabilitation centres follow the European Association of Urology Guidelines on Neuro‐Urology ; therefore, bladder management decisions revolve around urodynamic factors, hand function, continence, and patient quality of life . The systematic variation of catheter use with age, sex, and functional independence accordingly reflects up‐to‐date and personalized neuro‐urological patient management.…”

Nerve growth factor does not seem to be a biomarker for neurogenic lower urinary tract dysfunction after spinal cord injury

“…The main concern in these patients is upper urinary tract damage as a result of high bladder storage and voiding pressures, which are primarily the consequence of detrusor overactivity (DO) or low bladder compliance combined with detrusor‐sphincter‐dyssynergia . The diagnosis of NLUTD and the monitoring of the treatment effectiveness or the progression of NLUTD is based on (video‐) urodynamic investigations . However, urodynamic investigations are invasive, expensive, time‐consuming, and carry the risk of injury to the lower urinary tract and urinary tract infections .…”

Lack of efficacy of an intradural somatic-to-autonomic nerve anastomosis (Xiao procedure) for bladder control in children with myelomeningocele and lipomyelomeningocele: results of a prospective, randomized, double-blind study

“…5 Clean intermittent catheterization (CIC), the use of bladder-active medications (BAMs), and close urological follow-up can mitigate many of the potentially life-threatening complications of neurogenic bladder dysfunction, but patients' quality of life (QOL) is considerably affected by the lifelong burden of these interventions, the lack of control of their ability to empty their bladders, and by incontinence and sexual dysfunction. 4,5,9,10,13,15,21,25,[28][29][30] For more than 100 years, researchers and clinicians have pursued a myriad of surgical remedies to allow reinnervation of the urinary bladder, attempting a variety of nerve repair and transfer techniques in experimental animals and in humans. 11 While there has been great success in the clinical use of nerve transfer techniques to reinnervate peripheral nerves of the extremities, 3 there is no surgical nerve transfer or repair procedure that is widely used in patients with neurogenic bladder dysfunction.…”