Management of neurogenic bladder patients in The Netherlands: do urologists follow guidelines?

AIMS: Preventive measurements are obligatory for optimal treatment of neurogenic bladder patients. We investigated Dutch urological practice in neurogenic bladder patients in relation to the available guidelines on neurogenic bladder.

METHODS: A 12-point survey was sent to all 304 certified urologists of the Dutch Urological Association in July 2007. Management of urinary tract infections (UTI), follow-up of the lower and upper urinary tract and treatment techniques were topics of inquiry.

RESULTS: The response rate was 46% of which 94% were involved in treatment of neurogenic bladder patients. Follow-up was performed every 6 or 12 months in 86%, urine analysis respectively in 85% and upper urinary tract imaging with ultrasound in 60%; only 12% routinely repeated urodynamics. Uncomplicated UTI was treated for 7.1 days in women and 9.2 days in males. Eighteen percent used the EAU guidelines on neurogenic bladder frequently, 35% did occasionally and 47% did not use them at all. Urologists, that used these guidelines frequently, treated asymptomatic UTIs significantly less frequent in patients on intermittent catheterization (5% vs. 25%; P = 0.008); no difference was found in frequency of follow-up, urine analysis, surveillance of upper urinary tract, use of routine urodynamics, and availability of treatment techniques. Video urodynamics, the golden standard, was used by only 11% of the adult urologists.

CONCLUSION: The majority of Dutch urologists is involved in the treatment of neurogenic bladder, which suggests a less prominent role for specialized centers. Furthermore, urodynamics are not performed routinely. These observations are contrary to the recommendations of the available guidelines.