Surveillance of bladder management in a local cohort of neuro-urology patients

Abstract

BACKGROUND: Several neurological conditions, including multiple sclerosis and spinal cord injury, can give rise to a neurogenic bladder. Without proper management and regular surveillance, the sequelae of a neurogenic bladder can be devastating, including recurrent urinary tract infections, urolithiasis, and worst of all, renal failure, all of which continue to negatively impact these patients’ quality of life. There are two main guidelines available, developed by the European Association of Urologists (EAU) and National Institute of Clinical Excellence (NICE), to aid clinicians in the management of these patients. While both guidelines promote patient risk stratification into high and low risk categories for renal complications, there are several areas of discordance between them.

METHOD: In this retrospective audit, 58 neuro-urology patients who underwent video-urodynamics within a 6-year period were included, to determine whether they were properly followed-up, according to their risk category, as per the NICE guidelines.

RESULTS: Surveillance rate in the local cohort of neuro-urology patient was low. This could be attributed to the differences between the two guidelines, creating doubt and hesitancy in decision-making in the caring urologists, thus making their application in clinical practice more difficult. Other contributing factors include the lack of proper registries, and the lack of international evidence-based literature in the field.

CONCLUSION: Through this audit, we aim to emphasise the importance of further international research, as well as, creating a neuro-urology patient database within the local National Healthcare System (NHS) to ensure an optimal surveillance process.