Current practice patterns in the urologic surveillance and management of patients with spinal cord injury

Razdan, Sanjay; Leboeuf, Line; Meinbach, David S.; Weinstein, David A.; Gousse, Angelo E.

doi:10.1016/s0090-4295(02)02518-9

Cited by 74 publications

(45 citation statements)

References 11 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%

“…Up to 65% of respondents performed urodynamics annually or every other year for lower tract monitoring. 11 However, it is the position of this study that the annual use of urodynamics for urinary tract surveillance is not necessary. The objective of this study is to report the efficacy of a renal tract surveillance method based on annual retroperitoneal ultrasonography without the use of routine UDS in our population of SCI patients managed with long-term intermittent catheterization.…”

mentioning

confidence: 98%

“…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%

mentioning

confidence: 98%

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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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“…This could potentially be explained by the fact that neurogenic bladders are often more refractory to medical therapies, as previously pointed out by several groups. [15][16][17] Combining 2 drugs with the same mode of action is not unique (e.g., triple therapy in HIV treatment), 18 but this is also clearly not a widespread concept. The main concern is that not only the therapeutic benefits may be synergistic or additive, but side effects may as well.…”

Section: Discussionmentioning

confidence: 99%

Double anticholinergic therapy for refractory neurogenic and non-neurogenic detrusor overactivity in children: Long-term results of a prospective open-label study

Nadeau

Schröeder

Moore

et al. 2014

CUAJ

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Introduction: In this study, we optimize pharmacotherapy in children who failed anticholinergic monotherapy by simultaneous administration of 2 anticholinergics (oxybutynin and/or tolterodine and/or solifenacin). Methods: This report is an update of our previously published study on double anticholinergic regimen in children with refractory incontinence due to neurogenic (NDO) and non-neurogenic (DO) detrusor overactivity. Patients with an insufficient response (clinically/urodynamically) to an optimized dose of a single anticholinergic (oxybutynin or tolterodine) received a second anticholinergic (tolterodine or solifenacin), in addition to the pre-existing medication. The primary end-point was efficacy (continence) and the secondary end-points were tolerability and safety. The Patient Perception of Bladder Condition (PPBC) scale was used to rate subjective improvement of patients. Results: In total, 56 patients with DO (n = 31) or NDO (n = 25) were enrolled at a mean age of 11.4 ± 3.5 years and were followed for a minimum of 3 months. The duration of double treatment was 36 ± 23 months. Our results found that 23 patients became dry, 18 improved significantly and 15 improved moderately. Urodynamic capacity improved from 158 ± 87 mL to 359 ± 148 mL and maximal pressure of contractions decreased from 76 ± 24 to 22 ± 22 cmH 2 O (p < 0.0001). The overall success rate was 82%, since 10 patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 28 patients, mild side effects by 20, moderate side effects by 8; 2 patients withdrew from the study due to their side effects. Of the 35 patients who voided spontaneously, 8 developed post-void residuals (>20%). Conclusions: With a larger cohort and prospective follow-up, we reiterated that double anticholinergic regimen in children with DO or NDO refractory to anticholinergic monotherapy is a feasible and efficient approach.

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“…6 In the case of cervical cord injury, however, some patients cannot perform CIC by themselves, depending on their degree of tetraplegia. Independent CIC is performed at the level of C6B1.…”

Section: Discussionmentioning

confidence: 99%

Urinary tract management in patients with incomplete cervical cord injury during the recovery phase

et al. 2012

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Purpose: For patients with incomplete cervical cord injuries, appropriate urinary management based on an assessment of voiding and storage function of the bladder is necessary for a better prognosis, especially during the recovery phase. In our review of medical records of such patients, we identified factors related to recovery of bladder function and parameters for predicting prognosis. Methods: In this study, we included 234 patients with incomplete cervical cord injuries admitted to Kanagawa Rehabilitation Hospital. Their medical records were retrospectively reviewed for various parameters related to final urinary management measures at discharge. Parameters included age, severity of paralysis, bladder function over time, urinary sensation and cystometry results. Results: Patients were managed using urethral catheterization, suprapubic cystostomy, clean intermittent catheterization (CIC) by oneself or care givers, CIC with occasional spontaneous voiding, or spontaneous voiding alone. Bladder function improved in majority of the patients during hospitalization. The severity of paralysis and urinary sensation are predictive parameters for improvement in voiding function. In patients who were admitted with catheterization but were discharged with spontaneous voiding, the period for recovery was 85.2 days on average (range 16-142 days). Conclusions: Selection of urinary management measures for patients with incomplete cervical cord injuries can be performed adequately by considering the severity of paralysis and urinary sensation.

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Current practice patterns in the urologic surveillance and management of patients with spinal cord injury

Cited by 74 publications

References 11 publications

Renal Tract Ultrasonography for Routine Surveillance in Spinal Cord Injury Patients

Renal Tract Ultrasonography for Routine Surveillance in Spinal Cord Injury Patients

Double anticholinergic therapy for refractory neurogenic and non-neurogenic detrusor overactivity in children: Long-term results of a prospective open-label study

Urinary tract management in patients with incomplete cervical cord injury during the recovery phase

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