Surveillance urodynamics for neurogenic lower urinary tract dysfunction: A systematic review

Introduction: Baseline urodynamic characterization in patients with neurogenic lower urinary tract dysfunction (NLUTD) allows detection of unsafe storage and voiding pressures and optimization of these parameters through medical or surgical intervention. Surveillance urodynamics (sUDS) studies are performed in the ambulatory setting after baseline characterization, with the goal of monitoring bladder function. How often this study should be performed and the circumstances that should prompt repeated studies are unknown. The primary objective of this review is to evaluate the evidence supporting sUDS in the setting of NLUTD as assessed by whether the study leads to 1) change in patient management; 2) determination of new findings not suggested by imaging or symptoms; and 3) demonstration of superior outcomes compared to observation. The secondary objective is to review sUDS practice patterns among urologists in their assessment of NLUTD. Methods: PubMed, EMBASE, and Cochrane Library databases were reviewed for English-language literature published between January 1975 and March 2018. Results: Twenty-eight independent articles (1368 patients, 9486 patient-years of followup) were included. Given heterogeneous data, 49% of 263 subjects were asymptomatic, yet demonstrated sUDS abnormality prompting treatment. Eight cross-sectional studies (four spinal cord injury [SCI], two NLUTD, two spina bifida) surveyed urologists regarding current sUDS patterns; 53% of 498 respondents perform sUDS between one and three years. Conclusions: Evidence supporting optimal surveillance for NLUTD is lacking. Level 2b‒4 evidence suggests that sUDS is likely to modify patient treatment and often demonstrates findings that modify treatment in the absence of symptoms or imaging changes.