对CUA神经源性膀胱指南有效性的前瞻性评估。
A prospective assessment of the validity of the CUA neurogenic bladder guideline.
作者信息
Abed Haider, Hassouna Magdy, Aldossary Nader, Mckibbon Mary, Welk Blayne
机构信息
Department of Surgery, Western University, London, ON, Canada.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
出版信息
Can Urol Assoc J. 2023 Aug 29;17(12):404-10. doi: 10.5489/cuaj.8439.
INTRODUCTION
The Canadian Urological Association (CUA) neurogenic bladder guideline surveillance strategy for neurogenic lower urinary tract dysfunction (NLUTD) has not been formally evaluated. Our objective was to evaluate the validity of the risk stratification suggested in these guidelines.
METHODS
This was a prospective, observational cohort study of adult NLUTD patients with spinal cord injury, multiple sclerosis, or spina bifida who required urodynamics. Patients with a requirement for immediate bladder surgery (not suitable for surveillance) were excluded. Patients completed standardized medical history/questionnaires, baseline urodynamics, renal imaging, and creatinine tests. The primary outcome was the need for different types of urological management between the high-risk and moderate-risk groups.
RESULTS
We enrolled 68 patients; most commonly, these were spinal cord injury patients, and most people were using intermittent catheters. At baseline, 62% (40/68) were classified as high-risk. In this group, there was a numerically greater proportion who received a recommendation for a new urological medication (48% vs. 25%, p=0.06) or a change to their bladder management (45% vs. 36%, p=0.44). A total of 26 high-risk and 23 medium-risk NLUTD patients had a one- year followup visit. A larger proportion of the high-risk patients had a recommendation for a new bladder medication (15.4% vs. 8.7% p=0.47), intravesical onabotulinum toxin (34.6% vs. 13% p=0.08), or an alternate method of bladder management (15.4% vs. 4.3%, p=0.2). Mean creatinine change was slightly greater in the high-risk group (+6.1 vs. +0.4 umol/L, p=0.05). Approximately 1/3 of both high-risk and moderate-risk patients didn't accept the recommended interventions.
CONCLUSIONS
A higher proportion of high-risk NLUTD patients had urology-relevant interventions recommended, both at baseline and at their one-year followup visit. This supports the general concept of risk stratification and the variables used to define high-risk in the CUA's neurogenic bladder guideline.
引言
加拿大泌尿外科协会（CUA）针对神经源性下尿路功能障碍（NLUTD）的神经源性膀胱指南监测策略尚未得到正式评估。我们的目的是评估这些指南中建议的风险分层的有效性。
方法
这是一项针对患有脊髓损伤、多发性硬化症或脊柱裂且需要进行尿动力学检查的成年NLUTD患者的前瞻性观察队列研究。需要立即进行膀胱手术（不适合监测）的患者被排除在外。患者完成标准化病史/问卷、基线尿动力学检查、肾脏成像和肌酐测试。主要结局是高危组和中危组之间对不同类型泌尿外科管理的需求。
结果
我们纳入了68例患者；最常见的是脊髓损伤患者，大多数人使用间歇性导尿管。基线时，62%（40/68）被归类为高危。在该组中，接受新的泌尿外科药物推荐的比例在数值上更高（48%对25%，p=0.06）或膀胱管理方式改变的比例更高（45%对36%，p=0.44）。共有26例高危和23例中危NLUTD患者进行了为期一年的随访。高危患者中接受新膀胱药物推荐的比例更高（15.4%对8.7%，p=0.47）、膀胱内注射肉毒杆菌毒素A的比例更高（34.6%对13%，p=0.08）或采用替代膀胱管理方法的比例更高（15.4%对4.3%，p=0.2）。高危组的平均肌酐变化略大（+6.1对+0.4 umol/L，p=0.05）。大约1/3的高危和中危患者未接受推荐的干预措施。
结论
无论是在基线还是在一年随访时，高危NLUTD患者接受泌尿外科相关干预措施推荐的比例更高。这支持了风险分层的总体概念以及CUA神经源性膀胱指南中用于定义高危的变量。
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