背景:神经源性膀胱(NB)是一种常见的泌尿系统疾病,显着影响受影响个体的健康和生活质量。条件,通常由各种病因引起,如脊髓损伤和多发性硬化症,导致严重的生活问题,包括疼痛和身体受损,心理,社会,和情感功能。本研究旨在探讨泌尿科医师在诊断、管理,以及在巴勒斯坦医疗保健背景下对NB患者的护理,强调缺乏统一的治疗方案和依赖私人诊所进行护理。
方法:采用探索性定性研究设计,遵守定性研究报告综合标准(COREQ)清单。对巴勒斯坦八个不同城市的14名泌尿科医师和两名泌尿科居民进行了结构化访谈,包括10家政府医院,两家私立医院,一所大学医院,还有一家慈善医院.14名医生在医院工作的同时还设有私人门诊诊所。作者制定的问卷被送到专家和居民,以了解评估,管理,后续做法,以及治疗NB患者面临的挑战。这项研究的重点是诊断过程,治疗方式,并发症管理,以及缺乏标准化方案对患者护理的影响。我们的定性研究包括六大主题,每个主题由多个子主题和不同的参与者反应组成:(1)NB患者的诊断和随访;(2)NB管理中的一般问题;(3)NB患者上下泌尿系统功能的评估和随访;(4)与NB疾病相关的尿路感染以及如何处理;(5)NB患者治疗的意见和未来态度;(6)多发性硬化患者的NB.
结果:研究发现,尿动力学研究对NB诊断至关重要,然而没有统一的管理协议,导致不同的做法。在没有巴勒斯坦协议的情况下,大多数参与者更喜欢美国泌尿外科协会(AUA)指南。出现了六大主题,包括诊断和后续挑战,NB管理中的一般问题,泌尿系统功能的评估和随访,尿路感染管理,对未来治疗方向的意见,以及多发性硬化症NB患者的具体考虑。
结论:该研究强调需要统一,巴勒斯坦NB患者管理的标准化方案。对国际准则的依赖,主要是AUA协议,强调了地方医疗政策的差距。调查结果要求制定国家指导方针,增加资源,以有效管理NB,旨在改善患者的预后和生活质量。
BACKGROUND: Neurogenic bladder (NB) is a prevalent urologic condition significantly impacting the health and quality of life of affected individuals. The condition, often resulting from various etiologies such as spinal cord injuries and multiple sclerosis, leads to severe life problems, including pain and impaired physical, mental, social, and emotional functioning. This study aims to explore the medical practices of urologists in the diagnosis, management, and care of NB patients within the Palestinian healthcare context, highlighting the absence of a unified treatment protocol and the reliance on private clinics for care.
METHODS: An exploratory qualitative study design was employed, adhering to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Structured interviews were conducted with 14 urologists and two urology residents across eight different cities in Palestine, including 10 governmental hospitals, two private hospitals, one university hospital, and one charity hospital. Fourteen doctors had private outpatient clinics alongside their work in hospitals. A questionnaire developed by the authors was delivered to specialists and residents to understand the evaluation, management, follow-up practices, and challenges faced in treating NB patients. The study focused on the diagnostic processes, treatment modalities, complications management, and the impact of the lack of standardized protocols on patient care. Our qualitative study consists of six major themes, each theme consisting of multiple sub-themes and different participant responses: (1) diagnosis and follow-up of NB patients; (2) general issues in the management of NB; (3) evaluation and follow-up of upper and lower urinary system function in NB patients; (4) urinary tract infections associated with NB disease and how to deal with it; (5) opinions and future attitudes in the treatment of NB patients; (6) NB in patients with multiple sclerosis.
RESULTS: The study found that urodynamic studies are crucial in NB diagnosis, yet there is no unified management protocol, leading to varied practices. Most participants preferred the American Urological Association (AUA) guidelines in the absence of Palestinian protocols. Six major themes emerged, including diagnosis and follow-up challenges, general issues in NB management, evaluation and follow-up of urinary system function, urinary tract infections management, opinions on future treatment directions, and specific considerations for NB patients with multiple sclerosis.
CONCLUSIONS: The study highlights the need for a unified, standardized protocol for the management of NB patients in Palestine. The reliance on international guidelines, primarily the AUA protocols, underscores the gap in local healthcare policies. The findings call for the establishment of national guidelines and enhanced resources for the effective management of NB, aiming to improve patient outcomes and quality of life.