Przydacz Mikolaj, Chlosta Piotr, Corcos Jacques
Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada.
Department of Urology, Jagiellonian University, Medical College, Kraków, Poland.
Int Urol Nephrol. 2018 Jun;50(6):1005-1016. doi: 10.1007/s11255-018-1852-7. Epub 2018 Mar 22.
To review currently available guidelines and recommendations regarding urological follow-up of patients after spinal cord injury (SCI) and present an evidence-based summary to support clinicians in their clinical practice.
Maximum data were collected according to different methods, including searches with multiple and specific keywords, reference checks, gray literature searches (congress reports, working papers, statement documents), and browsing-related Web site access. Obtained data were analyzed with the modified version of the Oxford grading system for recommendations using levels of evidence (LE) and grades of recommendation (GR).
Different surveillance strategies exist, but there is no consensus among authors and organizations. As a result, practice patterns vary around the world. The present review indicates that proper urological follow-up of SCI patients should consist of medical history (LE 1-4, GR B-C), clinical examination (LE 4, GR C), renal laboratory tests (LE 1-3, GR B), imaging surveillance of the upper urinary tract (LE 1-3, GR A-B), urodynamic study (LE 2-4, GR B-C), and cystoscopy/cytology (LE 1-4, GR D). Clinicians agree that SCI patients should be followed up regularly with an individually tailored approach. A 1-year follow-up schedule seems reasonable in SCI patients without additional risk factors of renal deterioration (LE 3-4, GR C). In those who manifest risk factors, report changes in bladder behavior, or present with already developed complications of neurogenic bladder dysfunction, follow-up plans should be modified with more frequent checkups (LE 4, GR C). Urodynamic study should be repeated and considered as a routine monitoring strategy.
Individuals with neurogenic lower urinary tract dysfunction are at increased risk of multiple complications. Nevertheless, proper follow-up after SCI improves the prognosis for these patients and their quality of life.
回顾目前关于脊髓损伤（SCI）患者泌尿外科随访的指南和建议，并提供基于证据的总结，以支持临床医生的临床实践。
通过多种不同方法收集最大量数据，包括使用多个特定关键词进行检索、参考文献核对、灰色文献检索（会议报告、工作文件、声明文件）以及浏览相关网站。使用证据水平（LE）和推荐等级（GR）的牛津分级系统修订版对获得的数据进行分析。
存在不同的监测策略，但作者和组织之间尚未达成共识。因此，世界各地的实践模式各不相同。本综述表明，对SCI患者进行适当的泌尿外科随访应包括病史（LE 1 - 4，GR B - C）、临床检查（LE 4，GR C）、肾脏实验室检查（LE 1 - 3，GR B）、上尿路影像学监测（LE 1 - 3，GR A - B）、尿动力学研究（LE 2 - 4，GR B - C）以及膀胱镜检查/细胞学检查（LE 1 - 4，GR D）。临床医生一致认为，SCI患者应采用个体化定制的方法进行定期随访。对于没有肾脏恶化额外风险因素的SCI患者，1年的随访计划似乎是合理的（LE 3 - 4，GR C）。对于那些表现出风险因素、报告膀胱行为改变或已出现神经源性膀胱功能障碍并发症的患者，应通过更频繁的检查来修改随访计划（LE 4，GR C）。尿动力学研究应重复进行，并被视为一种常规监测策略。
神经源性下尿路功能障碍患者发生多种并发症的风险增加。然而，SCI后的适当随访可改善这些患者的预后及其生活质量。
