Ведение пациентов с нейрогенным мочевым пузырем: результаты опроса урологов Российской Федерации.

Abstract

Introduction. Neurogenic bladder is a dysfunction of the lower urinary tract (LUT) caused by damage to the nervous system at both the central and peripheral levels. Choosing the optimal approach to treating each individual patient with neurogenic bladder dysfunction is a difficult task for the urologist. Tactics require an individual approach, taking into account the cause of the disease, the severity of both urological and neurological symptoms, and the risk of complications. Published global data show that actual clinical practice diverges from the recommendations approved in these countries for the management of patients with neurogenic bladder. Similar studies have not been conducted in Russia. The purpose of this work is to evaluate the clinical practice of urologists in the Russian Federation in the treatment of patients with neurogenic bladder. Materials and methods. The survey of physicians was conducted on a specialized professional Internet resource for urologists, Uroweb.ru. An invitation to participate in the survey was posted in the form of a banner, and mailings were sent via email and instant messengers. A total of 250 Russian doctors took part in the study, which lasted from 07/07/23 to 12/30/23. Results. The survey demonstrated the choice of methods for monitoring the condition of the upper and lower urinary tract by urologists, and the frequency of examinations during long-term monitoring. A voiding diary as a simple and accessible method of monitoring bladder emptying patterns is recommended by 61.8% of urologists; 27.7% recommend a voiding diary only once at the initial visit, and 5.2% never use a voiding diary as a diagnostic method for their patients. 46.6% of respondents perform residual urine monitoring every 3 months, 33.7% of urologists prefer to do this once every 6 months, while 4.8% will perform monitoring only once a year. 58% of doctors recommend washing the cystostomy. The survey reflects options for prescribing pharmacotherapy for neurogenic urination disorders. Conclusions. Most Russian urologists partially follow national recommendations on the principles of diagnosis and treatment of neurogenic bladder. However, there is no consensus on the treatment of hyperand hypoactive forms of urinary tract dysfunction. There are still cases of unjustified use of antibacterial therapy, as well as outdated methods of managing drained patients. The results of the study emphasize the relevance of educational programs and interdisciplinary conferences in neurourology in all regions. Providing equipment for uroflowmetry, including home testing, for ultrasound diagnostics of residual urine, and urodynamic monitoring systems could improve the situation with neurourological patients. It is necessary to conduct schools for patients and their relatives, training them to care for neurourological patients, including patients with cystostomy.