A survey of clinical practice concerning long-term follow-up of neurogenic lower urinary tract dysfunction due to spinal cord injury in Italy.

The Journal of Spinal Cord Medicine Pub Date : 2022-11-01 Epub Date: 2021-04-13 DOI:10.1080/10790268.2020.1863899
Elena Andretta, Maria Cristina Pagliacci, Cristina Zuliani, Maria Teresa Filocamo, Ernesto Losavio, Andrei Krassioukov
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引用次数: 1

Abstract

Context/objective: This study aimed to assess the clinical practice for long-term follow-up (FU) of neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) in Italy and compare this practice with the clinical practice in other countries and with the international guidelines.

Design: Data concerning the long-term urological FU of individuals with SCI were collected using a questionnaire and analyzed by means of descriptive and inferential statistics.

Setting: Twenty-one Italian centers following SCI patients.

Participants: One physician at each center (either a permanent staff member or chief).

Outcome measures: Questions addressed the treatment of urinary tract infections (UTI), frequency of visits, urinary tract imaging examinations and urodynamic tests (UD), distinguishing between suprasacral and sacral SCI.

Results: Nineteen out of 21 centers completed the survey. In most centers, patients were recommended to undergo a visit and an ultrasound examination of urinary tract (UT) at least once a year. While the median interval between FU visits was identical (12 months) for individuals with suprasacral and sacral SCI, the two interval distributions were significantly different (suprasacral SCI: min-max 4-18, IQR = 6; sacral SCI: min-max 6-24; IQR = 8.5; P = 0.02), showing people with suprasacral SCI are followed up more often. Approximately 80% of the surveyed centers performed scheduled UD, with a yearly median frequency of 12 months (range 6-36) for patients with suprasacral SCI, as compared to a median frequency of 18 months for sacral SCI (range 0-36, P = 0.04). VideoUD and antibiotic prophylaxis for recurrent UTIs are carried out only by urologists in 63% and 47.4% of the centers, respectively. Overall, Italian centers share common strategies that compare to standards, including yearly visits, yearly UT examinations and stricter follow-up of people with suprasacral SCI, but may not have standard protocols for antibiotic prophylaxis of UTI, and in few cases control visits and UD are carried out too often.

Conclusions: Even though most Italian centers follow up patients with NLUTD secondary to SCI according to international guidelines, heterogeneity in frequency of FU examinations still exists. A tailored approach to the SCI patient that minimizes unnecessary examinations and groups different tests in a single access could improve patients' compliance with FU and reduce costs for the Health system.

意大利脊髓损伤所致神经源性下尿路功能障碍长期随访的临床调查。
背景/目的:本研究旨在评估意大利脊髓损伤(SCI)所致神经源性下尿路功能障碍(NLUTD)长期随访(FU)的临床实践,并与其他国家临床实践和国际指南进行比较。设计:采用问卷调查的方式收集SCI患者长期泌尿系FU的相关数据,并采用描述性统计和推理统计的方法进行分析。环境:21个意大利中心跟踪脊髓损伤患者。参与者:每个中心各一名医生(长期工作人员或主任)。结果测量:问题涉及尿路感染(UTI)的治疗,就诊频率,尿路成像检查和尿动力学检查(UD),区分骶上和骶上脊髓损伤。结果:21个中心中有19个完成了调查。在大多数中心,建议患者每年至少进行一次尿路超声检查(UT)。虽然骶上和骶上脊髓损伤患者FU检查的中位间隔相同(12个月),但两个间隔分布有显著差异(骶上脊髓损伤:min-max 4-18, IQR = 6;骶部SCI:最小-最大6-24;iqr = 8.5;P = 0.02),表明骶上脊髓损伤患者的随访频率更高。大约80%的调查中心进行了预定的UD,对于骶上SCI患者,每年的中位数频率为12个月(范围6-36),而对于骶上SCI患者,每年的中位数频率为18个月(范围0-36,P = 0.04)。分别有63%和47.4%的中心仅由泌尿科医生对复发性尿路感染进行oud和抗生素预防。总的来说,意大利的中心与标准相比有共同的策略,包括每年一次的检查,每年一次的UT检查和对骶上脊髓损伤患者更严格的随访,但可能没有抗生素预防UTI的标准方案,在少数情况下,对照访问和UD进行得太频繁。结论:尽管大多数意大利中心根据国际指南对脊髓损伤继发NLUTD患者进行随访,但FU检查频率的异质性仍然存在。针对脊髓损伤患者量身定制的方法可以最大限度地减少不必要的检查,并将不同的检查分组在一次访问中,可以提高患者对FU的依从性,并降低卫生系统的成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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