Variation in urological practice amongst spinal injuries units in the UK and Eire

Bycroft, John; Hamid, Rizwan; Bywater, H.; Patki, Prasad; Craggs, Michael; Shah, Julian

doi:10.1002/nau.20005

Cited by 27 publications

(22 citation statements)

References 25 publications

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“…17 However, there is little data relating to the value of sequential urodynamic testing, thus there is currently a wide variability in the management strategies amongst specialists. 10,11 Nosseir and colleagues retrospectively investigated the long-term results of 80 SCI patients managed at their institution with a strictly urodynamic-based treatment regime and determined that physiologic changes in bladder function can occur in the absence of changes in overall symptoms, thus they recommended annual urodynamic testing in patients with detrusor overactivity. 18 With the hypothesis that annual UDS is unnecessary, we retrospectively assessed our population of SCI patients managed with CIC to report the efficacy of a surveillance regime based on annual renal tract ultrasonography without annual UDS.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, data relating to the value of sequential ultrasonography or urodynamic testing are scarce, thus there is great variability in urologic management of these patients in the United States and around the world. [9][10][11] A 2002 survey of 160 US Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) members by Razda and colleagues revealed that 80% of respondents performed annual ultrasound for upper tract surveillance. Up to 65% of respondents performed urodynamics annually or every other year for lower tract monitoring.…”

mentioning

confidence: 99%

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Renal Tract Ultrasonography for Routine Surveillance in Spinal Cord Injury Patients

Edokpolo

Foster

2013

Topics in Spinal Cord Injury Rehabilitation

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Objectives:To report the efficacy of a urinary tract surveillance regime based on annual renal tract ultrasound without routine use of urodynamic testing (UDS) in our population of spinal cord injury (SCI) patients managed with clean intermittent catheterization (CIC). Methods: Data was gathered retrospectively from the records of 48 SCI patients (40 males and 8 females). After establishing a safe system with initial urodynamics, renal ultrasonography was done annually for surveillance. UDS was repeated only when patients presented with new symptoms. The primary endpoint was the report of ultrasound findings at last follow-up. Findings of dilatation, calculi, scarring, and reflux were noted. Results: Mean follow-up was 6.8 years. By final follow-up, pelvicaliectasis was present in 4 (8%) subjects. Mild-moderate hydronephrosis was present in 3 (6%) subjects: 1 stable and 2 (4%) new compared to initial assessment. No severe cases of hydronephrosis were noted. Six (13%) subjects had renal/ureteral calculi. No new cases of renal cortical scarring or thinning were noted. One (2%) subject had high-grade reflux on UDS secondary to a double J stent. Conclusions: Data relating to the efficacy of sequential surveillance studies in SCI patients are scarce, thus there is great variability in urologic surveillance methods worldwide. Upper tract abnormalities detected in our patients were early consequences of acute obstruction rather than late manifestations of detrusor changes and could not have been prevented with more regular urodyamic testing. These results suggest that annual ultrasound monitoring without routine urodynamic testing is an effective surveillance strategy in SCI patients managed with CIC.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Renal Tract Ultrasonography for Routine Surveillance in Spinal Cord Injury Patients

Edokpolo

Foster

2013

Topics in Spinal Cord Injury Rehabilitation

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“…7 In addition, the current long-term management was compared with the published guidelines for compliance. The EAU guidelines 4 are not SCI specific but include SCI-associated NLUTD.…”

Section: Discussionmentioning

confidence: 99%

“…We sent the same questionnaire as in the earlier study 7 to the consultant urologists at the 12 SCI centres in the United Kingdom and Ireland (Appendix). If the filled questionnaire was not received after 1 month, a second questionnaire was sent.…”

Section: Methodsmentioning

confidence: 99%

“…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 British guidelines for the urological management of patients with SCI 5 and the consortium for spinal cord medicine in the United States.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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...

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Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury

Nosseir

Hinkel

Pannek

2006

Neurourology and Urodynamics

123

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Variation in urological practice amongst spinal injuries units in the UK and Eire

Abstract: The variation in urological practice amongst SIU in the UK and Eire is considerable. This finding supports the need for an increase in the level of collaboration and research.

Cited by 27 publications

References 25 publications

Renal Tract Ultrasonography for Routine Surveillance in Spinal Cord Injury Patients

Renal Tract Ultrasonography for Routine Surveillance in Spinal Cord Injury Patients

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

Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury

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