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

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. 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. 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. 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. (c) 2008 Wiley-Liss, Inc.