Real world treatment patterns in the neurogenic bladder population: a systematic literature review

Abstract

Myriad treatment modalities are available for neurogenic bladder (NGB) including behavioral therapies, oral pharmacotherapy, catheterization and surgical procedures. Little is known about how NGB patients are managed in the real world, how well patterns relate to clinical guidelines and how strategies may have changed over time. To address this gap, a systematic review (SR) was conducted using MEDLINE and EMBASE [1996–2017]. The inclusion criteria for studies were: (I) published in English; (II) conducted in human subjects; (III) reporting the treatment patterns/use in NGB; (IV) conducted in a real world setting. A narrative synthesis of results was conducted, comparing the results to current treatment guidelines. Percentage of treatment use was summarized using ranges. Eight studies met the inclusion criteria. Although most studies focused on spinal cord injuries (SCI), study designs and settings were heterogeneous. All data was collected before 2007. The most popular form of oral pharmacotherapy was antimuscarinics, used by 12.6–86.7% of patients; 0–100% of patients used catheterization techniques, 2.5–53.1% used reflex voiding (RV), and 0.2–55% underwent surgery. A notable amount of patients switched treatments. This SR revealed that numerous strategies have been used to manage NGB throughout the years and there has been a large variance in their use. Whilst there were some discrepancies, most practices matched recommendations made in current guidelines. Ultimately, this SR showed that there is a large gap of epidemiological studies conducted in the field of NGB and the authors felt that available data was insufficient to build a comprehensive picture of treatment patterns. Epidemiological studies using electronic medical records (EMRs) are necessary to advance our understanding of how treatment patterns have changed, and also build a comprehensive picture of how patients are managed in current practice.

<p>The Real Daily Need for Incontinence Aids and Appliances in Patients with Neurogenic Bladder Dysfunction in a Community Setting in Germany</p>

“…Although IC is considered the standard bladder evacuation method in NLUTD, little is known about how this recommendation is implemented in community-based life. To the best of our knowledge, there has been no published data regarding the required amount and type of urological A recent systematic review 5 on treatment patterns in neurogenic bladder patients reported a percentage of patients with IC varying between 0% and 84% with very low rates in two older studies in the US (30.5%, 29.1% 9,10 ). In more recent studies in Switzerland, the Netherlands, the US and Turkey 6,[11][12][13] the percentage was 41.3%, 42.6%, 59.2% and 77.9%, respectively.…”

“…One essential prerequisite for a long-term outcome with a low complication rate is the provision of an adequate quantity of high-quality urological aids and appliances. 3,4 To date, there have been few dedicated investigations on the actual individual voiding mode 5,6 and the number of bladder evacuations per day in outpatients with NLUTD. This results in a lack of objective data on the quantity of the urological aids and appliances needed.…”

Management strategies for lower urinary tract symptoms (LUTS) among people with multiple sclerosis (MS): a qualitative study of the perspectives of people with MS and healthcare professionals

“…Neurogenic lower urinary tract dysfunction (NLUTD) is defined as lower urinary tract symptoms secondary to neurological disease or central nervous system (CNS) injury [1][2][3][4] that results in disturbance of ascending or descending pathways to the bladder 5 . The International Continence Society (ICS) classify NLUTD based on clinical symptoms including storage phase symptoms, voiding phase symptoms, and post-micturition symptoms 1 .…”