Real World Treatment Patterns In The Neurogenic Bladder Population: A Systematic Literature Review

• Published in: Value in health Vol. 20; no. 9; p. A492
• Main Authors: Jaggi, A, Fatoye, F
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01.10.2017
• Subjects: Bladder; Epidemiology; Health care; Literature reviews; Medical disorders; Medical treatment; Mortality; Patients; Research subjects; Sphincter; Spina bifida; Surgery; Systematic review
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.530

OBJECTIVES: To describe the treatment patterns and management strategies of neurogenic bladder (NGB) in real-world settings. METHODS: A systematic review (SR) was conducted using MEDLINE and EMBASE (1996-2017). Key terms included a combination of neurogenic bladder, treatment patterns and epidemiological study. The inclusion criteria for studies were: 1) published in English; 2) conducted in human subjects; 4) reporting the treatment patterns/use in NGB (any neurogenic condition listed in the EAU guidelines); 5) conducted in a real world setting. Articles were reviewed for inclusion by an independent reviewer (AJ) and 10% were cross examined by a second independent reviewer (FF). A narrative synthesis of results was conducted and percentage of treatment use was reported in ranges. RESULTS: A total of eight studies met the inclusion criteria. Study designs, setting, and patient groups were notably heterogeneous and all data was collected before 2008. This SR found that the most commonly used management method amongst NGB patients was reflex voiding (RV) methods and catheterisation (CIC and IndUC). Data and commentary from three studies show that a notable amount of patients switched treatments. The most popular oral pharmacotherapies were alpha-blockers and antimuscarinics used for neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). One study which focused on spina bifida reported that the majority of patients underwent surgery. CONCLUSIONS: With passing time, clinicians have moved away from techniques associated with higher rates of complications and mortality. This has meant that in recent years, the survival chances of patients with NGB have increased. This suggests that current treatment patterns will be different from what was uncovered in this review. Epidemiological studies using electronic healthcare records (EHRs) are necessary to advance our understanding in how NGB patients are managed in current practice, and how well patterns relate to practice guidelines.