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• W2912173904 abstract "You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction I1 Apr 2015PD1-09 UROLOGICAL SURVEILLANCE AND MEDICAL COMPLICATIONS AFTER SPINAL CORD INJURY IN THE UNITED STATES Anne P. Cameron, Julie Lai, Christopher S. Saigal, J Quentin Clemens, and NIDDK Urological Diseases in America Project Anne P. CameronAnne P. Cameron More articles by this author , Julie LaiJulie Lai More articles by this author , Christopher S. SaigalChristopher S. Saigal More articles by this author , J Quentin ClemensJ Quentin Clemens More articles by this author , and NIDDK Urological Diseases in America ProjectNIDDK Urological Diseases in America Project More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.204AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complications from neurogenic bladder (NGB) after spinal cord injury (SCI) such as upper tract deterioration could potentially be preventable with adequate screening and urologic care. Our objectives are: 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. METHODS This retrospective cohort study utilized a 5% sample of Medicare data 2007–2010. The minimum adequate urologic surveillance was defined as a: urologist visit; serum creatinine; and upper urinary tract imaging study within the two year period of follow up. Each patient was classified to their most severe complication and implemented a multivariate linear regression model predicting level of complication. RESULTS Among the 7162 patients with SCI the majority were functionally paraplegic (82.4%) and Caucasian (80.9%). 4.9% received no screening studies over the two year period, 70.5% received some, but not all screening and 24.6% received all three screening tests. Patients travelled a mean of 21.3 ±27.5 miles to receive care from a urologist or a rehab center. A total of 35.7%% of patients saw a urologist during the two 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. Fully 35.8% of all patients had a minor complication during their two year follow up with the majority being cystitis (21.1% prevalence). 17.1% had a moderate complication and 8.0% had a severe complication. In our prediction model patient factors that correlated with increased complications included male gender, African American race, paraplegia and receiving some or all of the NGB recommended screening. Patient distance of travel to their treating physician (urologist or physiatrist) and age did not affect the rate of complications. CONCLUSIONS Most patients with SCI are not receiving the recommended screening for urological complications. These urological complications are common in this population. Better screening, particularly urological follow up is needed to provide the best care for this vulnerable population. Spinal Cord Injury None (n=350) Some surveillance (n=5049) Complete bladder surveillance (n=1763) Total (n=7162) SCI Level of injury: Tetraplegia 61 (4.8%) 954 (75.6%) 246 (19.5%) 1261 (17.6%) p< 0.0001 Paraplegia 289 (4.9%) 4095 (69.4%) 1517 (25.7%) 5901 (82.4%) Age (mean) 59.6 ±18.4 67.6 ±17.0 61.9±17.4 65.8±17.2 p< 0.0001 Male 199 (5.9%) 2073 (61.4%) 1107 (32.8%) 3379 (47.2%) p< 0.0001 Female 151 (4.0%) 2976 (78.7%) 656 (17.3%) 3783 (52.8%) Race/Ethnicity: White 268 (4.6%) 4109 (70.9%) 1416 (24.4%) 5793 (80.9%) p=0.015 Black 46(5.0%) 630 (68.6%) 243 (26.4%) 919 (12.8%) Other 36 (8.0%) 310 (68.9%) 104 (23.1%) 450 (6.3%) Travel distance to referral center 20.1 ±23.7 21.6±28.1 20.6±26.4 21.3±27.5 p=0.5 Region: Midwest 82 (5.2%) 1100 (69.4%) 402 (25.4%) 1584 (22.1%) p=0.027 Northeast 55 (4.2%) 892 (68.4%) 358 (27.4%) 1305 (18.2%) South 137 (4.6%) 2162 (71.9%) 708 (23.6%) 3307 (42.0%) West 76 (6.0%) 895 (70.8%) 294 (23.2%) 1265 (17.7%) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e38-e39 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anne P. Cameron More articles by this author Julie Lai More articles by this author Christopher S. Saigal More articles by this author J Quentin Clemens More articles by this author NIDDK Urological Diseases in America Project More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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• W2912173904 title "PD1-09 UROLOGICAL SURVEILLANCE AND MEDICAL COMPLICATIONS AFTER SPINAL CORD INJURY IN THE UNITED STATES" @default.
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