Real world treatment patterns in the neurogenic bladder population: a systematic literature review

Myriad treatment modalities are available for neurogenic bladder (NGB) including behavioral therapies, oral pharmacotherapy, catheterization and surgical procedures. Little is known about how NGB patients are managed in the real world, how well patterns relate to clinical guidelines and how strategies may have changed over time. To address this gap, a systematic review (SR) was conducted using MEDLINE and EMBASE [1996-2017]. The inclusion criteria for studies were: (I) published in English; (II) conducted in human subjects; (III) reporting the treatment patterns/use in NGB; (IV) conducted in a real world setting. A narrative synthesis of results was conducted, comparing the results to current treatment guidelines. Percentage of treatment use was summarized using ranges. Eight studies met the inclusion criteria. Although most studies focused on spinal cord injuries (SCI), study designs and settings were heterogeneous. All data was collected before 2007. The most popular form of oral pharmacotherapy was antimuscarinics, used by 12.6-86.7% of patients; 0-100% of patients used catheterization techniques, 2.5-53.1% used reflex voiding (RV), and 0.2-55% underwent surgery. A notable amount of patients switched treatments. This SR revealed that numerous strategies have been used to manage NGB throughout the years and there has been a large variance in their use. Whilst there were some discrepancies, most practices matched recommendations made in current guidelines. Ultimately, this SR showed that there is a large gap of epidemiological studies conducted in the field of NGB and the authors felt that available data was insufficient to build a comprehensive picture of treatment patterns. Epidemiological studies using electronic medical records (EMRs) are necessary to advance our understanding of how treatment patterns have changed, and also build a comprehensive picture of how patients are managed in current practice.