OBJECTIVE: To determine current trends in management and surveillance of the neurogenic bladder population by Canadian urologists who routinely work with and provide care for these patients.
METHODS: A questionnaire was mailed to members of the Canadian Urological Association. The assessment and follow-up of upper and lower urinary tract function in neurogenic bladder patients, their optimal frequency and management of related infections were the topics of inquiry.
RESULTS: One hundred and five of 602 urologists responded, for a response rate of 18%. Twenty-three (22%) of the respondents did not treat neurogenic bladder patients. Four out of five urologists who treated these patients favored a yearly renal ultrasound for routine surveillance of the upper urinary tract and routinely performed urodynamic studies for evaluation of the lower tract. Only a relatively small percentage used videourodynamics. Clean intermittent catheterization (CIC) was preferred for the management of neurogenic bladder in patients with emptying difficulties. Asymptomatic urinary tract infection (UTI) was preferably not treated. Symptomatic UTI was treated with antibiotics for 7 to 10 days by about 75% of the responding urologists, while 23% of female patients and 9% of male patients were treated for less than 7 days. Although most of the urologists had access to established treatment modalities, like CIC education and bladder augmentation, only 30% made use of botulinum toxin injections.
CONCLUSIONS: This study confirms that most urologists in Canada, working with neurogenic bladder patients, follow principles reported in the literature regarding the need for evaluation, surveillance, and management of the urinary tract. However, there is no consensus on the specific methods used for surveillance of the urinary system. The results emphasize the need for clear guidelines in this field of urology in Canada.