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Value of urodynamic findings in predicting upper urinary tract damage in neuro‐urological patients: A systematic review
Author(s) -
Musco Stefania,
PadillaFernández Barbara,
Del Popolo Giulio,
Bonifazi Matteo,
Blok Bertil F. M.,
Groen Jan,
‘t Hoen Lisette,
Pannek Jürgen,
Bonzon Jerome,
Kessler Thomas M.,
Schneider Marc P.,
Gross Tobias,
Karsenty Gilles,
Phé Véronique,
Hamid Rizwan,
Ecclestone Hazel,
CastroDiaz David
Publication year - 2018
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.23501
Subject(s) - medicine , spinal cord injury , spina bifida , urinary system , systematic review , population , lower urinary tract symptoms , randomized controlled trial , medline , pediatrics , spinal cord , environmental health , psychiatry , political science , law , prostate , cancer
Aim The main goals of neurogenic lower urinary tract dysfunction (NLUTD) management are preventing upper urinary tract damage (UUTD), improving continence, and quality of life. Here, we aimed to systematically assess all available evidence on urodynamics predicting UUTD in patients with NLUTD. Methods A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Statement was performed in March 2017. Only neuro‐urological patients assessed by urodynamics were included. Any outcome of upper urinary tract function were evaluated. Results Forty‐nine studies (1 randomized controlled trial, 9 prospective, and 39 retrospective case series) reported urodynamic data on 4930 neuro‐urological patients. Of those, 2828 (98%) were spina bifida (SB) children. The total number of adults was 2044, mainly having spinal cord injury (SCI) (60%). A low bladder compliance was found in 568 (46.3%) and 341 (29.3%) of the paediatric and adult population, respectively. Hydronephrosis (HDN) was detected in 557 children (27.8%) in 19/28 studies and 178 adults (14.6%), mainly SCI, in 14/21 studies. Nine out of 30 multiple sclerosis (MS) patients affected by HDN (16.8%) showed low compliance in 4/14 studies. Conclusions Patients with SB and SCI have a higher risk of developing UUTD (mainly reported as HDN) compared to those with MS. Reduced compliance and high DLPP were major risk factors for UUTD. Although our findings clarify the mandatory role of urodynamics in the management of NLUTD, standardization and better implementation of assessments in daily practice may further improve outcomes of neuro‐urological patients based on objective measurements, that is, urodynamics.