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.

中文翻译：

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意大利脊髓损伤所致神经源性下尿路功能障碍长期随访临床实践调查

背景/目标

本研究旨在评估意大利因脊髓损伤 (SCI) 引起的神经源性下尿路功能障碍 (NLUTD) 长期随访 (FU) 的临床实践，并将该实践与其他国家和地区的临床实践进行比较国际准则。

设计

使用问卷收集有关 SCI 患者长期泌尿 FU 的数据，并通过描述性和推论性统计分析。

环境

二十一个意大利中心跟踪脊髓损伤患者。

参加者

每个中心有一名医生（永久性工作人员或主任）。

结果措施

问题涉及尿路感染 (UTI) 的治疗、就诊频率、尿路影像学检查和尿动力学检查 (UD)，以及区分骶上和骶 SCI。

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 (UT) 就诊和超声检查。虽然 FU 就诊的中位间隔对于骶上和骶 SCI 患者是相同的（12 个月），但两个间隔分布有显着差异（骶上 SCI：最小-最大 4-18，IQR = 6；骶 SCI：最小-最大 6 –24；IQR = 8.5；P = 0.02)，表明骶上 SCI 患者的随访频率更高。大约 80% 的被调查中心进行了定期 UD，骶上 SCI 患者的年中位频率为 12 个月（范围 6-36），而骶 SCI 的中位频率为 18 个月（范围 0-36，P = 0.04）。仅 63% 和 47.4% 的中心的泌尿科医师分别对复发性 UTI 进行视频 UD 和抗生素预防。总体而言，意大利中心采用与标准相比的共同策略，包括每年就诊、每年 UT 检查和对骶上 SCI 患者进行更严格的随访，但可能没有 UTI 抗生素预防的标准方案，并且在少数情况下控制访问和 UD执行得太频繁了。

结论

尽管大多数意大利中心根据国际指南对继发于 SCI 的 NLUTD 患者进行随访，但 FU 检查频率的异质性仍然存在。为 SCI 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测试分组在一次访问中，可以提高患者对 FU 的依从性并降低卫生系统的成本。