Management and rehabilitation of neurologic patients with lower urinary tract dysfunction

Research output: Chapter in Book/Report/Conference proceedingChapter in a book

4 Citations (Scopus)

Abstract

Diverse lower urinary tract problems arise in neurologic disease, caused by dysfunctions of the bladder and outlet, both during urine storage and voiding. Most neurologic diseases cause some lower urinary tract dysfunction (LUTD), and the type of dysfunction is related to the location of the nervous system lesion. Clinical evaluation requires identification of risk factors for major morbidity, particularly renal dysfunction, and mechanisms underlying symptoms. A holistic approach is needed to cover influential aspects (e.g., cognitive function, mobility, and urinary tract infections) and related issues (e.g., sexual function, bowel function, and autonomic dysreflexia), requiring a multidisciplinary team. Comprehensive history and examination are supported by a bladder diary, urinalysis, and renal assessment, supplemented by urodynamic tests. The simplest classification of neurogenic LUTD describes both bladder and sphincter function, cataloging each structure as normal, overactive, or underactive. Treatment aims to protect life expectancy and improve quality of life, noting the possibility of neurologic disease progression and comorbid disorders. Conservative measures include fluid advice and assessment of suitable containment products. Urine storage can be improved with antimuscarinic medications, bladder injections with botulinum neurotoxin A, and less established methods such as nerve stimulation, intravesical instillations, and beta-3 agonist. For severe storage dysfunction, sacral neuromodulation or surgery to improve reservoir function, increase outlet resistance, or divert the urinary tract may be needed. Voiding is usually replaced by intermittent or indwelling catheterization, which has largely superseded triggered reflex voiding, bladder expression, or sphincterotomy. Treatment selection is hampered by a limited, low-quality evidence base.
Original languageEnglish
Title of host publicationNeurology of Sexual and Bladder Disorders
EditorsDavid Vodusek, F. Boller
PublisherAmsterdam:Elsevier
Pages451-468
Number of pages18
ISBN (Print)9780444632470
DOIs
Publication statusPublished - 2015

Publication series

NameHandbook of Clinical Neurology
Volume130
ISSN (Print)0072-9752

Structured keywords

  • Centre for Surgical Research

Keywords

  • neurogenic bladder
  • detrusor overactivity
  • intrinsic sphincter deficiency
  • urodynamics
  • detrusor sphincter dyssynergia
  • botulinum neurotoxin A
  • intermittent catheterization
  • autonomic dysreflexia

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