ChapterReview questionsOutcomes
1Does the use of clinical assessment, urine culture, a residual urine estimate or a bladder diary/frequency volume chart change the management of patients with neurological disease?
  • Change in outcomes
1Does the use of urodynamics (filling cystometry, leak point pressure measurements, pressure-flow studies of voiding, video urodynamics) direct treatment or stratify risk of renal complications (such as hydronephrosis)
2Do behavioural management programmes (timed voiding, voiding on request, prompted voiding, bladder retraining, habit retraining, urotherapy) compared with a) each other b) usual care, improve outcomes?
  • Frequency of voiding by day and night
  • No. of incontinence episodes per week
  • Patient and carer perception of symptoms
  • Treatment adherence
  • Adverse events
2What is the safety and efficacy of antimuscarinics compared with a) placebo or treatment as usual b) other antimuscarinics for the treatment of incontinence due to neurological disease/ overactive bladder due to neurological disease?
2What is the safety and efficacy of detrusor injections of botulinum toxin type A or B compared with a) usual care b) antimuscarinics c) augmentation cystoplasty in neurological disease?
2What is the safety and efficacy of augmentation cystoplasty compared with a) botulinum toxin b) usual care in neurological disease c) urinary diversion?
3Does pelvic floor muscle training with or without electrical stimulation or biofeedback compared with treatment as usual, improve outcomes?
3What is the safety and efficacy of urethral tape and sling surgery compared with a) bladder neck closure b) usual care in neurological disease?
  • Number of incontinence episodes per week.
  • Severity of incontinence.
  • Symptoms relating to bladder emptying, for example poor urinary stream, need for intermittent catheterisation.
  • Patients and carers’ perception of symptoms.
  • Adverse events, including urinary tract infections, renal complications, bladder stones and unscheduled hospital admissions.
  • Damage caused by catheterisation
3What is the safety and efficacy of artificial urinary sphincters compared with usual care in neurological disease?
  • Incontinence level – frequency and severity
  • Symptoms relating to bladder emptying
  • Quality of life / patient or carer perception of symptoms
  • Adverse events, including UTIs, renal complications, bladder stones, infection of prosthesis, device failure and unscheduled hospital admissions.
4What is the safety and efficacy of alpha blockers compared with a) other adrenergic antagonists b) placebo/usual care for the treatment of incontinence due to neurological disease?
  • Frequency of voiding by day and night
  • Urgency
  • Symptoms relating to bladder emptying, for example poor urinary stream
  • Q-max (maximum flow rate)
  • Residual urine volume
  • Adverse events, including postural hypotension and other unscheduled hospital admissions.
  • Treatment adherence
5Do prophylactic antibiotics compared with a) no treatment b) other antibiotics reduce the risk of symptomatic urinary tract infections?
6What are the long term risks associated with the long term use of intermittent catheterisation, indwelling catheters and penile sheaths?
6What is the safety and efficacy of the catheter valve compared with urinary drainage bags in neurological disease?
6What is the efficacy of the ileal conduit diversion compared with usual care in neurological disease?
7Does monitoring or do surveillance protocols improve patient outcomes?
8What interventions or configuration of services improve outcomes when a patient is transferred from child to adult services?
8For patients and their carers with lower urinary tract dysfunction associated with neurological disorders, what are the experiences of access to and interaction with services that address these issues?
8Does the provision of information and support regarding the different management systems improve patient outcomes?

From: 4, Methods

Cover of Urinary Incontinence in Neurological Disease
Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease.
NICE Clinical Guidelines, No. 148.
National Clinical Guideline Centre (UK).
Copyright © 2012, National Clinical Guideline Centre.

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