CUA: Neurogenic Lower Urinary Tract Dysfunction (2019): Difference between revisions

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 #'''<span style="color:#0000ff">U</span><span style="color:#ff0000">pper urinary tract deterioration (UUTD)'''
-=== <span style="color:#ff0000">Infection ===
+=== Infection ===
 * '''Sepsis'''
@@ Line 116: / Line 116: @@
 **'''<span style="color:#ff0000">Diagnosis and Evaluation'''
 ***'''The accepted definition of UTI in persons with NLUTD requires the presence of (3):'''
-****'''Leukocyturia'''
+***#'''Leukocyturia'''
-*****Consensus cut-off for leukocyturia is 100 leukocytes/mL or any leukocyte esterase activity on dipstick
+***#*Consensus cut-off for leukocyturia is 100 leukocytes/mL or any leukocyte esterase activity on dipstick
-****'''Bacteriuria'''
+***#'''Bacteriuria'''
-*****No evidence-based cut-off values for bacteriuria; '''generally accepted guidelines:'''
+***#*No evidence-based cut-off values for bacteriuria; '''generally accepted guidelines:'''
-******'''Any detectable concentration for suprapubic aspirate'''
+***#**'''Any detectable concentration for suprapubic aspirate'''
-******'''>102 cfu/ml (clean catheterized sample)'''
+***#**'''>102 cfu/ml (clean catheterized sample)'''
-******'''>104 cfu/ml (clean voided)'''
+***#**'''>104 cfu/ml (clean voided)'''
-****'''Clinical symptoms'''
+***#'''Clinical symptoms'''
-*****'''<span style="color:#ff0000">Signs and symptoms of UTI in SCI'''
+***#*'''<span style="color:#ff0000">Signs and symptoms of UTI in SCI'''
-*****#'''<span style="color:#ff0000">Fever'''
+***#*#'''<span style="color:#ff0000">Fever'''
-*****#'''<span style="color:#ff0000">Cloudy urine'''
+***#*#'''<span style="color:#ff0000">Cloudy urine'''
-*****#'''<span style="color:#ff0000">Malodorous urine'''
+***#*#'''<span style="color:#ff0000">Malodorous urine'''
-*****#'''<span style="color:#ff0000">Dysuria'''
+***#*#'''<span style="color:#ff0000">Dysuria'''
-*****#'''<span style="color:#ff0000">Urinary incontinence/failure of control or leaking around catheter'''
+***#*#'''<span style="color:#ff0000">Urinary incontinence/failure of control or leaking around catheter'''
-*****#'''<span style="color:#ff0000">Increased spasticity'''
+***#*#'''<span style="color:#ff0000">Increased spasticity'''
-*****#'''<span style="color:#ff0000">Malaise'''
+***#*#'''<span style="color:#ff0000">Malaise'''
-*****#'''<span style="color:#ff0000">Lethargy or sense of unease'''
+***#*#'''<span style="color:#ff0000">Lethargy or sense of unease'''
-*****#'''<span style="color:#ff0000">Back pain'''
+***#*#'''<span style="color:#ff0000">Back pain'''
-*****#'''<span style="color:#ff0000">Bladder pain'''
+***#*#'''<span style="color:#ff0000">Bladder pain'''
-*****#'''<span style="color:#ff0000">Autonomic dysreflexia'''
+***#*#'''<span style="color:#ff0000">Autonomic dysreflexia'''
 ***'''Urine cultures should always be obtained prior to antimicrobial therapy due to the increased risk of nosocomial and multidrug-resistant microorganisms'''
 **'''<span style="color:#ff0000">Management'''
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 ****'''<span style="color:#ff0000">Bladder management'''
 ***** '''<span style="color:#ff0000">When possible, CIC should be used over other methods'''
-***** '''Risk of UTI: Transurethral indwelling catheterization carries >5x risk of recurrent UTIs when compared to suprapubic catheterization and CIC'''. '''Risk of UTI comparable between suprapubic, condom catheter, and CIC.'''
+****** '''Risk of UTI: Transurethral indwelling catheterization carries >5x risk of recurrent UTIs when compared to suprapubic catheterization and CIC'''. '''Risk of UTI comparable between suprapubic, condom catheter, and CIC.'''
-****** '''Condom catheters are effective and safe in select NLUTD patients''' (low PVRs and bladder storage pressures) '''but are significantly associated with Pseudomonas and Klebsiella bacteriuria and an incidence of UTI comparable to CIC'''.
+******* '''Condom catheters are effective and safe in select NLUTD patients''' (low PVRs and bladder storage pressures) '''but are significantly associated with Pseudomonas and Klebsiella bacteriuria and an incidence of UTI comparable to CIC'''.
-***** '''Risk of stones: CIC and condom catheter lower risk than indwelling transurethral or suprapubic'''
+****** Risk of stones: CIC and condom catheter lower risk than indwelling transurethral or suprapubic
-***** <span style="color:#ff0000">'''Indwelling catheters should be changed every 2–4 weeks, with monthly being the most common interval.'''
+***** <span style="color:#ff0000">'''Indwelling catheters should be changed every 2–4 weeks, with monthly being the most common interval'''
 **** '''Antimicrobial prophylaxis'''
 ***** '''Routine antimicrobial prophylaxis for NLUTD UTI is not recommended for most patients'''