Medical management of neurogenic bladder in patients with spina bifida: A scoping review.

Autor: Fairchild RJ; Duke University School of Medicine, Durham, NC, USA. Electronic address: rjf27@duke.edu., Aksenov LI; Duke Department of Surgery, Division of Urology, Durham, NC, USA., Hobbs KT; Duke Department of Surgery, Division of Urology, Durham, NC, USA., Krischak MK; Duke University School of Medicine, Durham, NC, USA., Kaplan SJ; Medical Center Library and Archives, Duke University, Durham, NC, USA., Purves JT; Duke Department of Surgery, Division of Urology, Durham, NC, USA., Wiener JS; Duke Department of Surgery, Division of Urology, Durham, NC, USA., Routh JC; Duke Department of Surgery, Division of Urology, Durham, NC, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2023 Feb; Vol. 19 (1), pp. 55-63. Date of Electronic Publication: 2022 Oct 13.
DOI: 10.1016/j.jpurol.2022.10.016
Abstrakt: Introduction: Neurogenic bladder is a common source of morbidity in patients with spina bifida and can cause renal damage. Medical management may include imaging, urodynamic studies (UDS), laboratory testing, clean intermittent catheterization (CIC), and medication. There is ongoing debate regarding the optimal management regimen. Approaches are described by two paradigms: proactive and expectant management. In a proactive approach, invasive interventions like CIC and UDS are initiated before the onset of renal abnormalities. In expectant management, UDS, CIC, and medications are started after abnormalities are identified. In this scoping review, we aim to comprehensively review existing literature on outcomes of proactive and expectant management of neurogenic bladder in patients with spina bifida.
Methods: We searched multiple databases and screened articles for inclusion using PRISMA-ScR guidelines. Included studies reported clinical outcomes of any aspect of proactive or expectant neurogenic bladder management in patients with spina bifida.
Results: Ultimately, 74 articles were included for review including 67 cohort studies, 4 cross-sectional studies, 2 sequential cohort studies, and 1 randomized control trial. Eleven studies directly compared management strategies. There was substantial heterogeneity in study designs, management protocols, and reported outcomes. Most studies addressed multiple simultaneous aspects of management without specifically analyzing individual aspects. However, some commented on individual aspects of management including UDS (13), CIC (32), imaging (7), and medication (5). Although there was no consensus about optimal management, all direct comparisons of paradigms supported a proactive approach.
Conclusion: Our review identified a broad body of literature about optimal management of neurogenic bladder. Existing studies vary greatly in terms of treatment protocols, measured outcomes, and management recommendations. Overall, studies that directly compare management are scarce but favor proactive management. Given the implications on clinical outcomes, it is crucial to focus future work on directly comparing management strategies and isolating the effects of different individual management elements.
Competing Interests: Conflicts of interest None.
(Copyright © 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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