TY - CHAP
T1 - Management and rehabilitation of neurologic patients with lower urinary tract dysfunction
AU - Drake, Marcus
PY - 2015
Y1 - 2015
N2 - 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superseded triggered reflex voiding, bladder expression, or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.
AB - 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.
KW - neurogenic bladder
KW - detrusor overactivity
KW - intrinsic sphincter deficiency
KW - urodynamics
KW - detrusor sphincter dyssynergia
KW - botulinum neurotoxin A
KW - intermittent catheterization
KW - autonomic dysreflexia
U2 - 10.1016/B978-0-444-63247-0.00026-2
DO - 10.1016/B978-0-444-63247-0.00026-2
M3 - Chapter in a book
C2 - 26003260
SN - 9780444632470
T3 - Handbook of Clinical Neurology
SP - 451
EP - 468
BT - Neurology of Sexual and Bladder Disorders
A2 - Vodusek, David
A2 - Boller, F.
PB - Amsterdam:Elsevier
ER -