Highlights This first guideline on neurogenic lower urinary tract dysfunction from the American Urological Association and the Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction examined more than 20,000 citations for relevant literature on the diagnosis, evaluation, and treatment of this condition. condition. Recommendations for diagnosis and evaluation require stratification into low, moderate, high, or unknown risk with associated intervals for invasive and noninvasive evaluations. Low-risk patients have low-risk lesions, spontaneous evacuation with low residual urine, limited sequelae, normal renal function, and stable disease. Moderate-risk patients have conditions or sequelae that may be associated with high-risk disease (eg, suprasacral spinal cord injury) but generally reassuring evaluations. Low-risk patients do not require surveillance in the absence of changes in symptoms/complications. Moderate risk patients should undergo annual evaluation of renal function and upper tract imaging every 1 to 2 years with urodynamics reserved for changes in condition/imaging. High-risk patients are recommended to undergo annual imaging and renal function testing with repeat urodynamics for a concerning change in symptoms, condition, or imaging. |
The term neurogenic lower urinary tract dysfunction (NLUTD) refers to abnormal function of the bladder, bladder neck, and/or its sphincters related to a neurological disorder. Previous terminology commonly used “neurogenic bladder” to describe this condition. With the understanding that this is not just a problem confined to the bladder, NLUTD is the preferred way to describe the various voiding problems seen in patients with a neurological disorder.
In addition to lower urinary tract symptoms (LUTS), such as urinary incontinence and retention, patients with LUTNU may experience recurrent urinary tract infection (UTI) and autonomic dysreflexia (AD).
Non-urinary conditions such as sexual dysfunction, infertility, and intestinal dysfunction are also common in patients with NLUTD, but are not within the scope of this Guideline. Lastly, this is a guide for adult patients with NLUTD; Pediatric NLUTD will not be discussed.
Aim
The clinician treating patients with neurogenic lower urinary tract dysfunction (NLUTD) needs to balance a variety of factors when making treatment decisions. In addition to the patient’s urologic symptoms and urodynamic findings, other issues that may influence lower urinary tract management options include cognition, hand function, type of neurological disease, mobility, hand function/management. intestine and social and caregiver support.
This guide allows the clinician to understand the options available to treat patients, understand the findings that can be seen in NLUTD, and appreciate which options are best for each individual patient. This allows decisions to be made with the patient, in a shared manner, so that the patient’s quality of life can be optimized with respect to the management of their bladder.
Materials and methods
A comprehensive search for studies evaluating patients undergoing NLUTD evaluation, surveillance, management, or follow-up was conducted from January 2001 to October 2017 and rerun in February 2021 to capture the most recent literature. The main search returned 20,496 unique citations. After a title and abstract screen, the full texts of 3,036 studies were obtained.
During full-text review, studies were excluded primarily for not meeting PICO criteria. One hundred and eight four primary literature studies met the inclusion criteria and were included in the evidence base.
Results
This guideline was developed to inform clinicians about the appropriate evaluation, diagnosis, and risk stratification of patients with NLUTD and the available surgical and nonsurgical treatment options.
Additional statements regarding urinary tract infection and autonomic dysreflexia were developed to guide the clinician. This guideline is for adult patients with NLUTD and pediatric NLUTD will not be discussed.
Conclusions
Patients with neurogenic lower urinary tract dysfunction (NLUTD) should be risk stratified as low, moderate, high, or unknown risk. After diagnosis and stratification, patients should be monitored according to their risk level at regular intervals. Patients who experience new or worsening signs and symptoms should be reevaluated and risk stratification should be repeated.
