Neurological lower urinary tract dysfunction essential terminology

AIMS: To introduce basic concepts and definitions in the International Continence Society (ICS) Standardisation of Terminology in adult Neurogenic Lower Urinary Tract Dysfunction (NLUTD).

METHODS: Fundamental terminology in the ICS Standardisation of Terminology of Adult NLUTD was identified and summarised.

RESULTS: NLUTD is often associated with impairment of cognitive, motor, sensory and/or autonomic functions. Lesions are categorised into suprapontine, pontine/ suprasacral spinal, sacral spinal, cauda equina/ peripheral nerve or mixed lesions. People affected with neurological disease are also at risk of the conditions seen in the general population, such as benign prostate enlargement. Symptoms of NLUTD include alterations in bladder or urethral sensation and incontinence. Loss of urine can result from incontinence, involuntary passing of urine and factors that impair toilet use, incorporating problems such as impaired cognition urinary incontinence, impaired mobility urinary incontinence and voiding dysregulation. Signs may be discerned by physical examination and recording of a frequency volume chart or bladder diary. Urodynamic observations during filling cystometry may include altered sensations, neurogenic detrusor overactivity and reduced bladder compliance. During pressure flow studies, there may be detrusor underactivity or bladder outlet obstruction (BOO). BOO may be caused by various forms poorly co-ordinated muscle activity in the bladder outlet. Symptoms, signs and urodynamic observations may be useful in diagnosing the presence and specific location of neurological impairment.

CONCLUSIONS: The review provides a succinct summary of symptoms, signs and urodynamic observations as set out in the ICS Standard on Adult NLUTD.