The vast majority of patients, especially those in this cohort who all underwent significant inpatient rehabilitation, will need some type of urinary device for voiding.16 While there are obvious situations that would mandate a urology consult, there are also important potential screening tests and preventive counselling that urologists are

well-suited to offer. There are demonstrated advantages in terms of quality of life17 and complication rates18 with certain methods of bladder management – for these issues, a discussion with a urologist may help patients make a fully informed decision about the investigation and management of their bladder. We demonstrated that female patients with a TSCI were significantly less likely to be referred to a urologist compared to male patients. This is paradoxical given the importance female TSCI patients place NVP-AUY922 manufacturer on their bladder function19 and the high frequency at which they undergo urologic procedures.20 Reasons for this may be related to a tendency in patients to manage their bladder with an indwelling urethral catheter. The assumption could then be that the bladder is “treated,” and no further urologic intervention or consultation is necessary despite the potential long-term complications associated with permanent catheterization. Similarly, the greater functional

impairment of older patients post-TSCI versus younger patients21 and a preference for an indwelling catheter may account for the reduced urologic referral among patients >65 years of age. Current guidelines for the urologic management of TSCI patients are vague8 (“generally a urologic evaluation is done every year”) or based selleck chemicals llc on an investigation schedule selected by experts with little evidentiary basis to support the associated healthcare costs until and patient inconvenience, and little guidance on how to interpret abnormal results in the setting of an asymptomatic patient.7 In a sampling of Canadian urologists, 80% stated that they routinely use renal ultrasound and urodynamics to follow neurogenic bladder patients.11 Similar results were obtained from a survey of American members of the Society for Urodynamics and Female Urology.10

While these surveys provide an evaluation of the attitudes and optimal practice patterns of urologists, they do not measure actual performance or quantify patients who are never referred to a urologist for management. This study will be important for future evidence-based guidelines and selection of quality of care indicators. Limitations of this study include the use of administrative data, which provided a large and comprehensive patient sample, but with limited clinical details (such as the exact lesion level, functional impairment, or method of bladder management). We were unable to ascertain the reason for urologic assessment, and although this study addressed referral for urologic care, it did not measure the quality of such care.