Editing CUA: Neurogenic Lower Urinary Tract Dysfunction (2019) (section)

=== Other ===

==== PVR ====
* '''To address potential UTI risk and overflow incontinence; may prompt screening for upper tract deterioration'''
* In the non-NLUTD population, a value >300 mL is used to define chronic urinary retention.
*'''The need to treat PVR should be based on patient symptoms rather than an absolute number.'''

==== Urodynamics ====
* '''<span style="color:#ff0000">Gold standard for evaluating NLUTD''' 
*'''<span style="color:#ff0000">Necessary due to the absence of normal lower urinary tract sensation and the poor ability of symptoms to predict high-risk features.'''
* '''<span style="color:#ff0000">VideoUDS are preferred, as the additional correlation with imaging allows assessment of (3):'''
*# '''<span style="color:#ff0000">VUR'''
*# '''<span style="color:#ff0000">Abnormal bladder morphology'''
*# '''<span style="color:#ff0000">Behaviour of the urinary sphincters during voiding'''
** The availability of videoUDS is not universal; a voiding cystogram is an acceptable alternative in some cases
* '''<span style="color:#ff0000">Urodynamic findings associated with increased risk of urological complications (such as renal dysfunction, urinary infections, and incontinence) (4):'''
*#'''<span style="color:#ff0000">Neurogenic detrusor overactivity (NDO)'''
*#*'''Duration of the NDO contraction''' may predict renal deterioration
*#'''<span style="color:#ff0000">Impaired compliance'''
*#'''<span style="color:#ff0000">Reduced bladder capacity'''
*#'''<span style="color:#ff0000">High detrusor leak point pressure (DLPP)'''
*#*DLPP: defined as the lowest detrusor pressure at which urine leaks from the bladder in the absence of a detrusor contraction or increased abdominal straining
*#** A DLPP of >40 cm H2O has traditionally been cited as the cutoff above which a patient has a high risk of renal deterioration; however, this is based on a historical study of children with SB, and may not be applicable to adult NLUTD.
*#** As DLPP increases, so too does the risk of renal dysfunction due to an increased resting pressure in the bladder being transmitted to the kidneys.
*#** '''If a high DLPP only occurs at a volume greater than the usual capacity during the normal daily voiding pattern, then this DLPP may not be physiologically relevant.'''
*#** A low DLPP maintains low pressure drainage from the kidneys, however, this often results in urinary incontinence.

==== Voiding diaries ====
* '''Should be considered for all patients'''
* Allows the patient to self-reflect on their urinary habits and the physician to measure changes over time in a non-invasive manner and interpret urodynamic findings in the context of the patient’s day-to-day urinary patterns.

==== Validated questionnaires ====
* '''Optional'''
*Generally used for research purposes in the NLUTD population

==== Cystoscopy ====
* Should be reserved for situations where there is a clinical indication to assess either the urethra or bladder (such as suspicion of urethral strictures or false passages, bladder stones, or bladder cancer)