title: Lack of improvement after audit assessing the management of voiding dysfunction in patients with spinal cord injury: necessity for institutional guidelines.
abstract: BACKGROUND
  Standard management guidelines for voiding dysfunction in patients with spinal cord injury (SCI) do not exist and these patients are managed on the basis of institutional protocols or individual judgment of managing physicians.
  
  
  OBJECTIVE
  To notice general trends and improvements over a five-year period, in the institutional practices related to management of voiding dysfunction in SCI patients.
  
  
  METHODS
  A retrospective cross-sectional study was conducted by Neurosurgery and Urology services together. A nine years (June 1995-June 2004) internal clinical audit of urological management of SCI patients was compared with a similar audit conducted five years later (January 2008-June 2010). Comparisons were made using chi-square test. A p-value of <0.05 was considered statistically significant.
  
  
  RESULTS
  A total of 146 patients were compared (89-pre-audit, 57-post-audit). The quality of documentation of examination findings worsened over the two study periods (p = 0.002). Although determination of baseline serum creatinine improved to statistically significant levels (p = 0.019), no imaging for the kidneys was performed as baseline in the post-audit period (p = 0.000). Similarly the number of urodynamic studies performed decreased from 11% to 1.75% (p = 0.045). The number of urological consultations, however, increased from 26% to 31.58% (p = 0.452). During follow-up, only 17 (19.1%) patients in the pre-audit study period and 6 (10.5%) in the post-audit study period were voiding spontaneously.
  
  
  CONCLUSIONS
  Our study of two eras clearly demonstrated a worsening trend in quality of patient management, which can be corrected by agreeing upon and implementing standard guidelines for management of SCI patients.
authors.affiliation: Section of Urology, Department of Surgery, Aga Khan University Hospital, Karachi 74800, Pakistan.
authors.forename: Syed Johar
authors.initials: SJ
authors.lastname: Raza
authors.forename: Muhammad Shahzad
authors.initials: MS
authors.lastname: Shamim
authors.forename: Saniya Siraj
authors.initials: SS
authors.lastname: Godil
authors.forename: S Raziuddin
authors.initials: SR
authors.lastname: Biyabani
authors.forename: Muhammad Ehsan
authors.initials: ME
authors.lastname: Bari
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Atta ul Aleem
authors.initials: Au
authors.lastname: Bhatti
authors.forename: Saeed
authors.initials: S
authors.lastname: Soomro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010154:Pakistan; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D014555:Urination Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D055815:Young Adult