Urological Surveillance and Medical Complications after Spinal Cord Injury in the United States

Abstract

Objectives To evaluate national patterns of urologic follow up after SCI and the occurrence and predictors of urological complications. Methods This retrospective cohort study utilized a 5% sample of Medicare data 2007–2010. The minimum adequate urologic surveillance was defined as a: urologist visit; serum creatinine; and upper urinary tract imaging study within the two year period. Each patient was classified to their most severe complication in a multivariate linear regression model. Results Among the 7162 patients with SCI, the majority were functionally paraplegic (82.4%) and Caucasian (80.9%). 4.9% received no screening studies over the two year period, 70.5% received some, but not all screening and 24.6% received all three screening tests. Patients travelled a mean of 21.3 ±27.5 miles to receive care. A total of 35.7% of patients saw a urologist during the two year period, 48.6% had some form of upper tract evaluation, with the majority being CT scans and 90.7% had serum creatinine. Fully 35.8% of all patients had a minor complication during their two year follow up. 17.1% had a moderate complication and 8.0% had a severe complication. In our prediction model, patient factors that correlated with increased complications included male gender, African American race, paraplegia and receiving some or all of the NGB recommended screening. Patient distance of travel to their treating physician (urologist or physiatrist) did not affect the rate of complications. Conclusions Most patients with SCI are not receiving the recommended screening for urological complications which are common in this population.

The use of urologic investigations among patients with traumatic spinal cord injuries

“…Other studies have also demonstrated a poor adherence among other populations to urologic screening: among 7,162 patients with SCI in the USA, only 25% of patients received a urologic clinical assessment, serum creatinine analysis, and renal imaging study over a 2-year period; cystoscopy and urodynamics were only performed among 12% and 7%, respectively. 27 …”

Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction – Executive summary

“…[53][54][55] Typically, surveillance protocols suggest either on-demand or regularly scheduled UDS, upper tract imaging, and cystoscopy but there is little consensus on specific approach [3][4][5]56 Consequently, practice patterns vary with regard to the type and frequency of studies used in NLUTD surveillance. [56][57][58][59] Our suggested approach for NLUTD stratifies patients based on their urological risk factors and specific investigations are recommended.…”

“…While historically used for concerns of increased bladder cancer risk, cystoscopy can be a valuable tool in the evaluation of urethral or bladder integrity and can provide an estimate of external sphincter function. The value of surveil-Guideline: Neurogenic bladder lance cystoscopy for bladder cancer surveillance in the SCI population was addressed in a recent systematic review by Cameron et al 57 The investigators believed that the incidence of bladder cancer was too low to be well-evaluated in these studies, and screening cystoscopy and biopsy did not fit the criteria for a screening test of the general NLUTD population. Patients with prior augmentation cystoplasty have historically been followed with yearly surveillance cystoscopy due to increased risk of bladder cancer.…”

Surveillance urodynamics for neurogenic lower urinary tract dysfunction: A systematic review

“…Furthermore, there is no consensus if sUDS should be scheduled regularly or repeated for new patient symptoms or imaging changes. Consequently, practice patterns vary with regard to sUDS frequency (11)(12)(13)(14)(15)(16)(17) and health-care utilization data suggests low uptake of sUDS utilization in NLUTD within the United States and Canada (18,19) .…”