Practice patterns of Japanese physicians in urologic surveillance and management of spinal cord injury patients

Abstract

Study design: Analysis of answers to a new questionnaire. Objective: To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan. Setting: Nationwide questionnaire survey to physicians in Japan. Methods: A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS). Results: We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. The management of lower urinary tract (LUT) disorders is very important in order to prevent serious complications that may result in upper urinary tract (UUT) disorders such as hydronephrosis. There have been arguments as to the strategy of observation and therapeutic approaches in SCI patients. For improvement in life expectancy and quality, research and evidenced-based practices related to urinary tract dysfunction are requisite. Recently, results of questionnaires on the current practice patterns in urological surveillance and management of SCI patients were reported in the United States (US) and United Kingdom (UK).3,4 The present inquiry by questionnaire was performed on the current practice patterns of the physician (urologist) in urological management of SCI patients in Japan. Spinal Cord (2006) 44, 362-368 & 2006 International Spinal Cord Society All rights reserved 1362-4393/06 $30.00 www.nature.com/sc MethodsA Japanese version of the 14-item questionnaire (see Appendix A) with which a survey was carried out recently in the US 3 was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS) in January 2004. The society consists of urologists, neurologists, pharmacologists, and others. More than 90% of the members of the society are urologists. The number of urologists of JNBS is approximately 10% of the total members of the Japan Urological Association (JUA), which is the only official society of urologists in Japan. We thought that almost all of the members of JNBS were engaged more routinely in urologic management of patients with SCI than those of any other nationwide academic medical society. Answers to the questionnaire returned to us by the deadline (within 1 month) were analyzed in this study. The first eight questions concern surveillance of the neuropathic bladder and bladder cancer due to spinal cord lesions, and the remaining questions deal with treatment modality and background of the respondents. The US and Japanese questionnaires were not identical, because Razden et al 3 did not publish details of their questionnaire. ResultsWe received a response to our questionnaire from 388 (50.3%) members of JNBS. In all, 55 members declined to answer our questions because they were not engaged in urological management of SCI patients. A total of 333 (43.2%) urologists out of the JNBS members replied to our questions. Some of them did not answer all questions in the questionnaire because of unknown reasons. In total, 314 (40.8%) urologists a...

Management of neurogenic bladder patients in the Netherlands: do urologists follow guidelines?

“…The previous literature did not show consensus on the frequency of urodynamics requested by physicians. 2,3,5 The present study showed that only 12% of the Dutch urologists repeated routinely urodynamics. Furthermore, only 11% of the adult urologists perform video urodynamics, which is regarded as the golden standard by the EAU guidelines.…”

“…Available studies surveyed physicians involved in the treatment of SCI only. [2][3][4] For example, Bycroft et al 3 surveyed consultant urologists in spinal injuries units in the UK and Ireland on different aspects of neurogenic bladder dysfunction. They did not find any consensus on the frequency of visits, protocols for urinary tract infections and the need of routine urodynamics.…”

Bladder cancer in individuals with spinal cord injuries

“…Given the aggressive bladder tumors that can present in SCI patients, cystoscopies may not occur at a time to significantly influence management. Despite this, 95% of Japanese urologists believe in annual cystoscopy for SCI patients, 39 and an American survey found that 25% of urologists perform routine cystoscopy on all SCI patients whereas 75% perform yearly cystoscopy if the patient uses an indwelling catheter. 40 To date, guidelines have not recommended specific strategies to mitigate the morbidity and mortality associated with bladder cancer.…”

Bladder cancer in spinal cord injury patients

“…8 Others have advocated screening SCI patients with an indwelling catheter after 8-10 years of use with yearly cystoscopy, cytology, and possible biopsy. 9 11 show that the majority of urologists are performing annual cystoscopies for patients with long-term indwelling catheters, and 75-88% perform them if the patient has an indication such as hematuria or bladder stones. There has also been some interest in the use of urine tumor markers for screening.…”

“…Both of these findings have been noted in earlier studies. 3,11,[13][14][15][16] The reason for the rapid and aggressive nature of these tumors is unknown. In other populations with bladder cancer, approximately 25% will present with muscle invasive disease, 6 whereas in this study over 1/2 had advanced disease at presentation.…”