SCOTTSDALE, AZ USA (UroToday.com) - The objective of this retrospective cohort study was to assess the method of urologic follow up after SCI and to evaluate the occurrence and predictors of urological complications, including the impact of adequate bladder surveillance. The authors utilized a 5% sample of Medicare data from 2007–2010. The definition for minimum adequate urologic surveillance was: a urologist visit; serum creatinine; and upper urinary tract imaging study within the 2-year period of follow up.
Among the 7 162 patients with SCI, the majority were functionally paraplegic (82.4%) and Caucasian (80.9%). 4.9% received no screening studies over the 2-year period, 70.5% received some, but not all screening, and 24.6% received all 3 screening tests. Patients traveled more than 20 miles to receive care from a urologist or a rehab center. Only 35.7%% of patients saw a urologist during the 2-year period, 48.6% had some form of upper tract evaluation with the majority being CT scans (40.0% of entire cohort), followed by ultrasound (35.2%), and 90.7% had a creatinine drawn. 35.8% of all patients had a minor complication during their 2-year follow up with the majority being cystitis (21.1% prevalence). 17.1% had a moderate complication, and 8.0% had a severe complication. Those who had increased complications were male, African American race, and paraplegia.
The study conclusions were that urological complications are common in patients with SCI, but 75% of patients are not receiving even basic recommended urologic screening. Other observations were that distance of travel does not impact screening, and more education and robust guidelines are needed to provide the best care for this vulnerable population. Perhaps some of these complications could be prevented with adequate screening and urologic care.
Funding: NIDDK-HHSN276201200016C
Presented by A. P. Cameron, J. Lai, C. S. Saigal, and J. Q. Clemens at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Winter Meeting - February 24 - 28, 2015 - JW Marriott Camelback Inn Resort & Spa - Scottsdale, AZ USA
Reported by Diane K. Newman, DNP, FAAN, BCB-PMD, medical writer for UroToday.com.