13 SYSTEMATIC REVIEW OF UROLOGICAL FOLLOW UP AFTER SPINAL CORD INJURY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 201113 SYSTEMATIC REVIEW OF UROLOGICAL FOLLOW UP AFTER SPINAL CORD INJURY Anne P. Cameron, Katherine Schomer, and Gianna Rodriguez Anne P. CameronAnne P. Cameron Ann Arbor, MI More articles by this author , Katherine SchomerKatherine Schomer Seattle, WA More articles by this author , and Gianna RodriguezGianna Rodriguez Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.074AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is no consensus on the appropriate urological follow up of individuals after spinal cord injury (SCI), but it is well known that they are at risk for renal deterioration, bladder cancer, and stones. Our objective was to perform a systematic review of the literature to evaluate the evidence with respect to urologic screening in this population. METHODS 340 abstracts were reviewed with 53 articles meeting inclusion criteria. Authors rated evidence using American Academy of Neurology 2004 Guidelines. RESULTS Nine articles evaluated screening for bladder cancer. There is insufficient evidence to make recommendations regarding the use of urine survivin, BTA-stat or BLCA-4 and there were mixed results regarding the use of urine cytology. Two level III articles suggest that annual cystoscopy and biopsy do not fit criteria for a screening test. Twelve articles evaluated urinary tract infection (UTI) screening. >102 cfu/ml is established as the diagnostic criteria for bacteriuria in midstream catheterized urine. Patient reported symptoms used to predict UTI yielded mixed results. Dipstick testing of urine probably has the same accuracy as microscopy but its ability to predict UTI yielded mixed results. Routine urine cultures are possibly unnecessary in healthy asymptomatic individuals with normal urinalysis. Six articles support the use of periodic urodynamics (UDS), but an optimum frequency of such testing could not be determined from the data. There is sufficient evidence (nine articles) to recommend ultrasound of the urinary tract as a useful, non-invasive, and possibly cost effective method for routine long term follow up for detecting upper urinary tract problems. Five articles evaluated radioisotope renography and evidence is sufficient to recommend it as a good method for further testing, especially if the ultrasound is positive. There is conflicting evidence (two articles) on serum creatinine to detect early deterioration of renal function. Evidence is sufficient (five articles) to recommend ultrasound of urinary tract to detect urinary tract stones with good sensitivity. Intravenous urography and CT are useful for screening, but entail the use of intravenous contrast and radiation. Two articles have confirmed that plain film X-ray is not reliable to assess for urinary tract stones. CONCLUSIONS Based on this review no definitive recommendations for screening can be made except for routine renal ultrasonography. UDS is an important part of screening, but the frequency is unclear and the optimum bladder cancer screening has not been defined. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e5 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anne P. Cameron Ann Arbor, MI More articles by this author Katherine Schomer Seattle, WA More articles by this author Gianna Rodriguez Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...