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

=== Surgical management of LUTD ===

==== Indications ====

*'''When conservative measures, medical therapy, and minimally invasive interventions alone fail to achieve the objectives of:'''
*# Protecting kidney function and mitigating autonomic dysreflexia by maintaining bladder storage at safely low pressures
*# Ensuring adequate and timely bladder emptying to mitigate the risks of overflow incontinence, recurrent UTIs, bladder stones, and kidney damage
*# Preventing the adverse effects of incontinence (e.g., dermatitis)
*# Improving QoL by relieving bothersome symptoms of OAB and incontinence.

==== Options (5): ====

#'''<span style="color:#ff0000">Bladder augmentation'''
#'''<span style="color:#ff0000">Catherizable channel'''
#'''<span style="color:#ff0000">External urethral sphincterotomy'''
#'''<span style="color:#ff0000">Bladder neck closure with continent or incontinent channel'''
#'''<span style="color:#ff0000">Incontinent diversion'''

===== Bladder augmentation =====
* '''<span style="color:#ff0000">Indications (2):'''
*# '''<span style="color:#ff0000">Reduced compliance or NDO refractory to all other non-surgical treatments'''
*# '''<span style="color:#ff0000">Reduced bladder capacity necessitating an indwelling catheter or CIC to be done too frequently'''

===== Catheterizable channels and continent cutaneous urinary diversion =====
* '''<span style="color:#ff0000">In cases where urethral catheterization is precluded, a catheterizable channel may be offered</span>''' after careful consideration and multidisciplinary evaluation.
* '''The most commonly used tube is the appendix (Mitrofanoff appendicovesicostomy). Where the appendix is unavailable or unsatisfactory''' (must be 8–10 cm in length for adult patients), '''a segment of terminal ileum can be employed''' (Yang-Monti or Casale technique), albeit with slightly poorer outcomes.

===== External urethral sphincterotomy =====
* '''Contraindications (4):'''
*# '''Female'''
*# '''Unable to wear condom catheter'''
*# '''Detrusor underactivity'''
*# '''Patient wants to maintain fertility'''

===== Bladder neck closure combined with a continent or incontinent channel =====
* '''Indicated in cases of severe outlet damage'''

===== Incontinent urinary diversion (ileovesicostomy and ileal conduit) =====
* '''Last resort in managing the complications of NLUTD'''
* The bladder should be removed at the time of surgery to reduce the risks of pyocystis, chronic symptomatic cystitis, and malignancy