Veenboer Paul W, Ruud Bosch J L H, de Kort Laetitia M O
Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Neurourol Urodyn. 2014 Mar;33(3):289-95. doi: 10.1002/nau.22413. Epub 2013 Apr 23.
To investigate how urologists generally perform the follow-up of adult spina bifida (SB) patients and to see to which extent recommendations from guidelines on neurogenic lower urinary tract dysfunction are followed.
A self-designed electronic multiple choice questionnaire was sent to all 365 urologists in the Netherlands.
Overall 100 urologists (27.4%) responded, of which 96 (26.3%) responses were usable. Of 95 urologists, 18 (18.9%) saw no adult SB patients, 47 (49.5%) saw 1-5 patients/year, 15 (15.8%) saw 6-10, and 15 urologists (15.8%) saw >10 adult SB patients/year. Of 96 urologists, a specialized clinic for adult SB patients was present in only 11 (11.5%) cases. Ultrasonography was performed regularly (at least once every 1-5 years) by 68/74 (91.9%) urologists. Glomerular filtration rate (GFR) was determined at least every 5 years by 66/74 (89.1%) urologists. For determination of GFR, serum creatinine was most often used (94.5%). Renography and video-urodynamic investigations (UDS) were performed on a regular basis by 8.1% and 24.3%, respectively.
In adult SB patients, the responding Dutch urologists regularly evaluate bladder and kidney function using GFR and ultrasonography, although less frequently than recommended by the guidelines. UDS is performed on indication only, which is not in accordance with the guidelines. Regular UDS might be valuable to detect risk factors for insidious renal damage. The role of renography, as well as the desirability of multidisciplinary teams, has yet to be determined.
调查泌尿外科医生对成年脊柱裂（SB）患者进行随访的一般方式，并了解神经源性下尿路功能障碍指南的建议在多大程度上得到遵循。
向荷兰所有365名泌尿外科医生发送了一份自行设计的电子多项选择题问卷。
共有100名泌尿外科医生（27.4%）回复，其中96份（26.3%）回复可用。在95名泌尿外科医生中，18名（18.9%）未诊治成年SB患者，47名（49.5%）每年诊治1 - 5名患者，15名（15.8%）诊治6 - 10名，15名泌尿外科医生（15.8%）每年诊治超过10名成年SB患者。在96名泌尿外科医生中，仅有11例（11.5%）设有成年SB患者专科门诊。68/74（91.9%）的泌尿外科医生定期进行超声检查（至少每1 - 5年一次）。66/74（89.1%）的泌尿外科医生至少每5年测定一次肾小球滤过率（GFR）。对于GFR的测定，最常使用血清肌酐（94.5%）。肾图检查和影像尿动力学检查（UDS）的定期执行率分别为8.1%和24.3%。
在成年SB患者中，做出回复的荷兰泌尿外科医生定期使用GFR和超声检查评估膀胱和肾功能，尽管频率低于指南建议。UDS仅在有指征时进行，这与指南不符。定期进行UDS可能有助于发现隐匿性肾损伤的危险因素。肾图检查的作用以及多学科团队的必要性尚待确定。
