The Worldwide Economic Impact of Neurogenic Bladder

Self-esteem and quality of life in patients with neurogenic dysfunction and continent urinary diversion and/or procedures for anterograde enemas

INTRODUCTION AND OBJECTIVE

The importance of evaluating the self-esteem and quality of life of patients with a chronic disease has become increasingly relevant. The study describes self-esteem and quality of life outcomes in patients with neurogenic dysfunction and continent urinary diversions and/or antegrade enema procedures.

MATERIALS AND METHODS

Cross-sectional observational study, including patients with neurogenic dysfunction who required a continent urinary diversion and/or an antegrade enema conduit during their treatment. The self-esteem evaluation was done with the Rosenberg scale and the quality of life with the KIDSCREEN-27 questionnaire.

VARIABLES MEASURED

socio-demographic, clinical and economic characteristics. Descriptive statistics were applied.

RESULTS

The mean age of the 9 patients was 15.6 years, the mean time elapsed from surgery to application of the questionnaires was 60.9 ± 37.1 months. With a perception of improvement in 8 of the 9 patients and a normal or higher self-esteem score in all cases. In the description of physical activity and health, it was found that 7 of the 9 young people presented a perception of good health in general. A considerable reduction in the use of diapers was achieved after the intervention, going from consuming 6.2 ± 1.4 diapers per day to only 1.7 ± 1.3 diapers per day.

CONCLUSIONS

Despite the sequelae, comorbidities and procedures, the results of self-esteem and quality of life in patients with neurogenic dysfunction are high.

Establishing a core outcome set for neurogenic bladder trials: study protocol for a scoping review and Delphi surveys

Background

Neurogenic bladder (NGB) is a chronic and disabling condition with a high prevalence rate, which can cause economic burden on patients and their families and reduce the quality of life of patients. Researchers have carried out a large number of clinical trials on the effectiveness and safety of different interventions for the treatment of NGB. The published clinical trials of NGB generally suffered from inconsistent and irregular reporting of outcome indicators. To facilitate future research studies of NGB, a core outcome set (COS) is required, which helps translate the results into high-quality evidence.

Methods and analysis

This mixed-method project has four phases instrument: in phase 1, a scoping review of the literature to identify outcomes that have been reported in clinical trials and systematic reviews of clinical trials of interventions for NGB; in phase 2, a qualitative component using interviews to obtain the views of NGB patients, families, and their caregivers; in phase 3, Delphi survey among stakeholders to prioritize the core outcomes; and in phase 4, a face-to-face consensus meeting to discuss and agree on the final NBG COS.

Conclusions

We will develop a COS that should be reported in future clinical trials of NGB.

Trial registration

Core Outcome Measures in Effectiveness Trials (COMET) Initiative database registration: http://www.comet-initiative.org/studies/details/1985. Registered on 02 January 2022. INPLASY INPLASY202210007

Burden of illness the first year after diagnosed bladder dysfunction among people with spinal cord injury or multiple sclerosis - a Danish register study

BACKGROUND

People with spinal cord injury (SCI) or multiple sclerosis (MS) are often living with some degree of bladder and/or bowel dysfunction due to acquired neurogenic damage. The objective was to estimate the burden of illness of SCI and MS the first year after diagnosed bladder dysfunction.

METHODS

Data were extracted from registers covering all Danish citizens. People with SCI or MS were indexed at diagnosis of bladder dysfunction. Inclusion period was 2002-2015 and cases and matched controls were followed for one year.

RESULTS

A total of 2,132 subjects with SCI and 1,887 subjects with MS were identified. Healthcare utilization and societal costs per patient-year were significantly higher for cases compared to controls driven primarily by inpatient care. Cases with urinary tract infection had significantly higher inpatient costs per patient-year compared to controls (SCI: 544 EUR vs 23, p < 0.05; MS: 497 EUR vs 6, p< 0.05) and medication for constipation was significantly more costly per patient-year (SCI: 178 EUR vs 3, p < 0.05; MS: 78 vs 1, p < 0.05).

CONCLUSIONS

The study demonstrates heavy societal and personal costs in the first year after bladder dysfunction in people with SCI or MS. This emphasizes the need for medical and social interventions to reduce the burden of illness.

A prospective survey study of lower urinary tract dysfunction in childhood cancer survivors after vincristine and/or doxorubicin chemotherapy

BACKGROUND

Two chemotherapeutic agents used widely in pediatric oncology are vincristine (VCR) and doxorubicin (DOX), which may cause neuropathy and myopathy, respectively. The study hypothesis is that neurotoxic effects of VCR and/or myotoxic effects of DOX affect bladder physiology and manifest clinically as lower urinary tract dysfunction (LUTD).

PROCEDURE

Based on a priori power analysis, 161 children divided evenly by gender were recruited. Children aged 5-10 years completed the dysfunctional voiding scoring system (DVSS) survey. The study cohort comprised cancer survivors treated with VCR and/or DOX. Healthy controls were recruited from well-child clinic visits. Exclusion criteria included pelvic-based malignancy, pelvic irradiation, pre-existing LUTD, neurologic abnormalities, and treatment with cyclophosphamide/ifosfamide. DVSS scores and presence of LUTD, defined as DVSS scores above gender-specific thresholds (males ≥9, females ≥6), were compared across cohorts.

RESULTS

Median DVSS scores were higher in the study cohort (6 vs. 4, p = .003). Moreover, children in the study cohort were more likely to exceed threshold scores for LUTD (38.8% vs. 21%, p = .014; OR 1.8). Subanalysis by gender revealed female cancer survivors are more likely to report LUTD than controls (57.5% vs. 30%, p = .013, OR 1.9). This did not hold true for males (20% vs. 12.2%, p = .339).

CONCLUSIONS

Childhood cancer survivors who received VCR and/or DOX reported higher rates of LUTD than controls. Female cancer survivors appear more likely to suffer from LUTD than males. Further study with a positive control cohort of cancer survivors who received non-VCR, non-DOX chemotherapy is underway to elucidate the contribution of a cancer diagnosis to LUTD.

Understanding the Economic Impact of Neurogenic Lower Urinary Tract Dysfunction

Neurogenic bladder is a chronic and disabling condition associated with multiple comorbidities and a widespread economic impact. Literature on cost of care and resource utilization is sparse and heterogeneous. Nonstandardized approaches, impact perspectives, and types of costs are used to describe the economic implications of neurogenic bladder. The financial toll is difficult to ascertain due to indirect and intangible costs exacerbated by the underlying disability. Health resource utilization based on clinical manifestations of neurogenic bladder may serve as an alternative measure. Understanding the multifold economic implications and health resource utilization patterns of neurogenic bladder may guide improvement of treatment strategies.