Pediatric neurogenic bladder cases are not fully evaluated

Pediatric neurogenic bladder (NGB) cases are not fully evaluated in routine clinical practice, according to a study published online Oct. 16 in Advances in Therapy.

Naoko Izumi, from Pfizer Japan in Tokyo, and colleagues conducted a retrospective cohort study involving patients aged 17 years and younger with NGB to examine the current status of NGB management over a 24-month follow-up. Data were included for 883 eligible children, including 39.3 percent with spina bifida.

The researchers found that renal urinary tract ultrasound and urinalysis were performed at least once in >35 and >45 percent of patients over 12-/24-month post-index periods, respectively, while substantially fewer patients underwent specific tests (urodynamics, cystourethrography, scintigraphy; <11/<13 percent). Overactive bladder medications were used by 21.5 percent of patients over 24 months, and 10.8 percent of patients underwent clean intermittent catheterization (CIC) alone or with medications; 1.2 percent underwent surgery.

The most common incident complications were lower urinary tract infection (UTI), urinary incontinence, and hydronephrosis (23.2, 9.7, and 7.0 percent, respectively). In an analysis of risk factors for UTI, significantly higher odds ratios were seen for CIC, presence of spina bifida, and constipation (5.70, 2.86, and 2.07, respectively). There was inadequate performance of urodynamic assessments overall.

"Our present study shows that NGB cases are not fully evaluated in routine clinical practice, both for diagnostic and follow-up purposes, despite clear directions provided by the guidelines," the authors write. "This may hamper the ongoing management of these patients and adversely affect the outcomes."

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