Long-term urological management in spinal injury units in the UK and Eire: a follow-up study

Abstract

Aims: The majority of patients with spinal cord injury (SCI) will develop neurogenic lower urinary tract dysfunction (NLUTD). These patients require a long-term urological follow-up. The follow-up protocol has varied across SCI units in the United Kingdom and Eire. We reviewed the long-term management in the SCI units to identify changes in practice over a decade and compared them to current guidelines. Methods: We present results of a review of all SCI centres in the United Kingdom and Eire on their long-term urological management before and after the current guidelines and compared the results with European Association of Urology (EAU) Guidelines on NLUTD and the proposed British guidelines for the urological management of patients with SCI. Data were collected through questionnaires posted to SCI units. Results: SCI patients are followed up in outpatients annually in the SCI centres and the frequency of follow-up remains largely unchanged. More SCI units perform renal tract imaging annually as a part of SCI follow-up. Most units follow the proposed British guideline indications for urodynamics and do not perform 'routine urodynamics'. Conclusions: We conclude that the long-term management of SCI patients in SCI units in the United Kingdom and Eire has changed overtime to follow the proposed British guidelines. EAU guidelines offer a more extensive follow-up regime. Last, there is a continued lack of high-quality evidence to support an optimal long-term follow-up protocol. Importantly, there is a lack of evidence on clinical outcomes when these guidelines have been followed. Spinal Cord (2014) 52, 640-645; doi:10.1038/sc.2014.90; published online 10 June 2014 INTRODUCTIONThe annual incidence of spinal cord injury (SCI) is up to 40 cases per million. 1 Most of these patients develop neurogenic lower urinary tract dysfunction (NLUTD). 2 Mortality due to urological complications has decreased over recent years; 3 due to meticulous attention to the kidneys and bladder. Long-term urological follow-up is needed to optimise the bladder by low-pressure filling and complete bladder emptying. Restoration of continence is a goal for improved quality of life. 4 SCI patients are best managed in a SCI centre with integrated facilities for rehabilitation and a multidisciplinary approach: involving urologists, rehabilitation specialists, specialist nurses and physiotherapists etc. 5 Although it is agreed that patients with NLUTD should have regular follow-up, there is little concusses how this should be monitored over the long-term to detect urological complications. 6 We conducted a survey of SCI units in 2004 to evaluate the longterm urological management of SCI patients in the United Kingdom and Eire, which showed a considerable variation in urological practice among SCI centres in the United Kingdom and Eire. 7 Since then guidelines have been published on the management of NLUTD, and NLUTD in association with SCI. These include the European Association of Urology (EAU) guidelines for management of NLUTD, 4 proposed Britis...

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

“…After duplicates removal (n = 100), 147 of 180 screened articles were excluded because they were not related to the neuro-urological follow-up. In all, 23 of 33 full-text articles were included in the quantitative synthesis [1][2][3][4][5][6][7][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Thus, 10 articles were excluded because they did not bring additional information on the neuro-urological follow-up (six review articles, two case-reports, one animal model, one cross-sectional study) [25][26][27][28][29][30][31][32][33][34].…”

“…Burki et al [23] addressed the effects of the European Association of Urology (EAU) Guidelines on Neuro-Urology and the proposed British Guidelines for the Urological Management of Patients with SCI in the UK. These authors concluded that there was a continued lack of high-quality evidence to support an optimal long-term follow-up protocol.…”

The Utility of Urodynamic Studies in Neuro-Urological Patients

“…Recent studies in the UK showed an increase in adherence to the guidelines in recent years. A French survey observed that routine follow-ups including UDS were performed by 56% of urologists and 83% of physiatrists, most often annually [ 60 , 61 , 62 ].…”

Follow-up urodynamics in patients with neurogenic bladder

“…[ 9 ] Studies from UK showed improving compliance with guidelines in recent years, but most institutions were still not performing regular follow-up urodynamics. [ 21 22 ] A survey from France showed that routine follow-up urodynamics was performed by 56% of urologists and 83% of physiatrists, most often on an annual basis. [ 23 ] However, only 12% urologists in the Netherlands performed routine follow-up urodynamics despite European Association of Urology (EAU) guidelines recommendations.…”