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

=== Upper urinary tract deterioration (UUTD) ===
* CKD rates vary from 0.6–3.3% for MS, 1.3–5.6% for SCI, and up to 8% for SB patients, which is higher than that of the general population
* The pathophysiology of CKD in neurogenic bladder is not well-understood
* '''<span style="color:#ff0000">Potential risk factors for UUTD in NLUTD (5):'''
*# '''<span style="color:#ff0000">Bladder outlet obstruction'''
*# '''<span style="color:#ff0000">Ureteric obstruction'''
*# '''<span style="color:#ff0000">UTIs'''
*# '''<span style="color:#ff0000">Stones'''
*# '''<span style="color:#ff0000">Persistent high intravesical pressures (most important)'''
*#* '''High pressures could be from NDO, poor bladder compliance, DSD, ureteric obstruction,''' or a combination, and can '''cause subsequent VUR and UUTD'''.
*#** VUR may appear as hydroureteronephrosis on imaging.
*#* '''Symptoms of high intravesical pressure''' (e.g., leakage between CIC) '''are rarely present and UDS are required to properly identify it'''
*#* '''<span style="color:#ff0000">Since VUR and hydroureteronephrosis may be manifestations of high bladder pressures in neurogenic bladder, treatment should focus first on ensuring low storage pressure.'''
*#** '''<span style="color:#ff0000">Anti-reflux surgery or double-J ureteral stenting should be avoided in these cases.'''
* '''<span style="color:#ff0000">CIC is superior to chronic suprapubic or urethral catheterization for preserving bladder compliance'''
** Despite the fact that patients with a chronic indwelling catheter have an empty bladder most the time, they still warrant follow-up for urological complications and hydronephrosis
* Overall, patients at higher risk of UUTD are SB, suprasacral SCI, and men with MS. Clinically stable MS patients have lower rates of UUTD
* '''Lifelong upper tract surveillance of UUTD is recommended'''
** Renal function decline can occur up to 45 years after injury