Editing Neurogenic LUT Dysfunction (section)

=== Radial pelvic surgery ===
* '''LUT dysfunction after pelvic plexus injury occurs most commonly after abdominoperineal resection (APR) and radical hysterectomy'''
**'''The inferior hypogastric plexus (pelvic plexus) which innervates the viscera of the pelvic cavity is a paired structure located on the side of the rectum in males and at the sides of the rectum and vagina in females.'''
** Injury may occur from denervation or neurologic decentralization, tethering of the nerves or encasement in scar, direct bladder or urethral trauma, or bladder devascularization.
** Adjuvant treatment, such as chemotherapy or irradiation, may compound the damage.
** Other dysfunctions commonly associated with APR related to sexual activity include
***Ejaculatory dysfunction in males
***Vaginal dryness and dyspareunia in females
**Uncertainty  whether nonradical pelvic surgery such as simple hysterectomy can be ultimately responsible for storage or emptying abnormalities on the basis of neurologic damage
* ≈1/3 of patients have some element of urinary tract dysfunction (urinary frequency, urgency, and/or poor detrusor contraction resulting in retention and incomplete emptying). 
**The type of LUT dysfunction that occurs is dependent on the specific nerves involved, the degree of injury, and any pattern of reinnervation or altered innervation that occurs over time
**Patients often experience leakage across the distal sphincter area and are unable to empty the bladder, because, although intravesical pressure may be increased, they cannot mount a true bladder contraction. The patient often has urinary incontinence that is characteristically and most commonly initiated with increases in intra-abdominal pressure. This is usually most obvious in females, because the prostatic bulk in males often masks an equivalent deficit in urethral closure function. Alternatively, patients may have variable degrees of urinary retention.
* '''<span style="color:#ff0000">When permanent LUT dysfunction occurs after radical pelvic surgery, usually pattern of impaired bladder contractility or a failure of the bladder to voluntarily contract.</span>'''
** '''UDS may show'''
*** '''Residual fixed striated sphincter tone, which is not subject to voluntarily induced relaxation, and may result in obstruction'''
*** '''Often, the smooth sphincter is open and nonfunctional.'''
*** '''<span style="color:#ff0000">Decreased compliance is common</span>, and, with the “obstruction” caused by fixed residual striated sphincter tone, may result in both storage and emptying failure.'''
* '''<span style="color:#ff0000">Management</span>'''
** '''<span style="color:#ff0000">Upper tract risk factors are related to intravesical pressure and the detrusor leak point pressure, and the therapeutic goal is always low-pressure storage with periodic emptying.</span>'''
** '''<span style="color:#ff0000">Most of these dysfunctions will be transient, and patients can be discharged on CIC with full urodynamic evaluation at a later date.</span>'''
*** '''<span style="color:#ff0000">Frequently, 6-12 months may elapse before detrusor function returns to an acceptable level</span>'''
**'''In males, prostatectomy should be avoided unless a clear bladder outlet obstruction is demonstrated at this level. Otherwise, prostatectomy simply decreases urethral sphincter function and thereby may result in the occurrence or worsening of sphincteric urinary incontinence.'''
'''Simple and radical hysterectomy'''
* '''Women who undergo hysterectomy by the vaginal approach may be more likely to have micturition symptoms as compared with abdominal approach patients'''
* As compared with simple hysterectomy, radical hysterectomy may have more debilitating effects on bladder and bowel function