Blok Bertil F M, Karsenty Gilles, Corcos Jacques
Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Can J Urol. 2006 Oct;13(5):3239-43.
To determine current trends in management and surveillance of the neurogenic bladder population by Canadian urologists who routinely work with and provide care for these patients.
A questionnaire was mailed to members of the Canadian Urological Association. The assessment and follow-up of upper and lower urinary tract function in neurogenic bladder patients, their optimal frequency and management of related infections were the topics of inquiry.
One hundred and five of 602 urologists responded, for a response rate of 18%. Twenty-three (22%) of the respondents did not treat neurogenic bladder patients. Four out of five urologists who treated these patients favored a yearly renal ultrasound for routine surveillance of the upper urinary tract and routinely performed urodynamic studies for evaluation of the lower tract. Only a relatively small percentage used videourodynamics. Clean intermittent catheterization (CIC) was preferred for the management of neurogenic bladder in patients with emptying difficulties. Asymptomatic urinary tract infection (UTI) was preferably not treated. Symptomatic UTI was treated with antibiotics for 7 to 10 days by about 75% of the responding urologists, while 23% of female patients and 9% of male patients were treated for less than 7 days. Although most of the urologists had access to established treatment modalities, like CIC education and bladder augmentation, only 30% made use of botulinum toxin injections.
This study confirms that most urologists in Canada, working with neurogenic bladder patients, follow principles reported in the literature regarding the need for evaluation, surveillance, and management of the urinary tract. However, there is no consensus on the specific methods used for surveillance of the urinary system. The results emphasize the need for clear guidelines in this field of urology in Canada.
确定加拿大泌尿外科医生对神经源性膀胱患者进行管理和监测的当前趋势，这些医生日常诊治并护理此类患者。
向加拿大泌尿外科协会成员邮寄了一份调查问卷。询问内容包括神经源性膀胱患者上、下尿路功能的评估和随访、其最佳频率以及相关感染的管理。
602名泌尿外科医生中有105名回复，回复率为18%。23名（22%）受访者不治疗神经源性膀胱患者。在治疗这些患者的泌尿外科医生中，五分之四倾向于每年进行肾脏超声检查以对上尿路进行常规监测，并常规进行尿动力学研究以评估下尿路。只有相对较小比例的医生使用影像尿动力学检查。对于排空困难的神经源性膀胱患者，清洁间歇性导尿（CIC）是首选的管理方法。无症状尿路感染（UTI）最好不进行治疗。约75%的回复泌尿外科医生对有症状的UTI使用抗生素治疗7至10天，而23%的女性患者和9%的男性患者治疗时间少于7天。尽管大多数泌尿外科医生可以采用既定的治疗方式，如CIC教育和膀胱扩大术，但只有30%的医生使用肉毒杆菌毒素注射。
本研究证实，加拿大大多数诊治神经源性膀胱患者的泌尿外科医生遵循文献中报道的关于尿路评估、监测和管理必要性的原则。然而，在泌尿系统监测的具体方法上尚未达成共识。结果强调了加拿大泌尿外科这一领域需要明确的指南。
