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Telemedicine appears viable for neurogenic bladder


Among 321 scheduled telemedicine visits for patients with neurogenic bladder, the compliance rate was 91%.

Telemedicine can improve management of neurogenic bladder, decreasing the risk of urinary tract infection (UTI), researchers say.

All the patients in a recent trial of telemedicine said they were satisfied, reported Lynn Stothers, MD, MHSc, of Bladder Care Centre, University of British Columbia, and clinicians liked it too.

"You can gain insight into the patient in their own home environment," she told Urology Times.

Dr. Stothers presented the findings at the AUA annual meeting in San Francisco.

UTI is the most common secondary health complication of spinal cord injury, she reported. It is associated with septicemia, resistant organisms, autonomic dysreflexia, and reduced quality of life.

To determine whether telemedicine can help monitor physiologic parameters to reduce UTIs in this population, Dr. Stothers and her colleagues recruited 55 patients with neurogenic bladder (41 male, 14 female). To participate, the patients had to have a personal computer with Internet access from home.

Patients ranged in age from 23 to 70 years. Spinal cord injury was the cause of neurogenic bladder in 47, multiple sclerosis in four, and spina bifida in four. Two subjects used adaptive mouth technology to operate telemedicine independently.

The authors monitored the subjects for 6 months to establish a baseline, then instituted telemedicine for 6 months. They built video conferencing software specifically for this project and an adaptive platform with features allowing those with high injury levels using second blow technology to participate independently.

Patients were given blood pressure cuffs, thermometers, and urine dipsticks for home monitoring with software linkage to input these measures. The monitoring also included a wireless near infra-red spectroscopy device worn suprapubic.

They conducted standardized telemedicine visits monthly for 6 months, with subjects reporting home monitoring measurements and bladder symptoms. For 321 scheduled visits, the authors documented a compliance rate of 91%. Software operated successfully in 79% of these visits.

Data on UTIs were available for 41 participants during the telemedicine period. The average number of UTI occurrences per person was lower during the telemedicine period than during the run-in period. This decrease was limited to 19 of the 41 participants.

Out of 205 urine samples, the authors identified 130 bacterial isolates. Of these, 47 were symptomatic, 49 had no growth, 24 had mixed organisms, and 89 were multi-drug resistant.

The most common bacterium identified was Escherichia coli,followed by Klebsiella pneumoniae, Pseudomonas aerginosa, and Staphylococcus aureus.

Next:High marks from satisfaction surveys

On satisfaction surveys, all the patients agreed or strongly agreed that they were satisfied with telemedicine home monitoring and would recommend it to others.

Ninety-five percent said they would consider it for future health services. Eighty-sevenpercent said it increased their motivation to monitor their health. Seventy-one percent said that discussions of UTI were helpful.

Read: Nocturia Tx shows efficacy across age groups

The technique could prove particularly helpful for people living in remote areas, said Dr. Stothers. But mobility is a challenge in general for people with spinal cord injuries and similar neurologic disorders, she said.

"One of the barriers is physically getting to the clinic,” Dr. Stothers said.

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