CUA: Neurogenic Lower Urinary Tract Dysfunction (2019): Difference between revisions
Urology4all (talk | contribs) Created page with " '''See Original Guideline''' ===== '''Defintions''' ===== * '''Definition of neurogenic lower urinary tract dysfunction (NLUTD): lower urinary tract dysfunction due to disturbance of the neurological control mechanism''' ** This broad definition is used to describe a multitude of conditions of varying severity ===== '''Causes of NLUTD''' ===== * '''Neurological conditions commonly associated with LUT dysfunction (3):''' *# '''Multiple sclerosis (MS)''' *# '''Spina..." |
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'''See Original Guideline''' | '''See Original Guideline''' | ||
== | == Definitions == | ||
* '''Definition of neurogenic lower urinary tract dysfunction (NLUTD): lower urinary tract dysfunction due to disturbance of the neurological control mechanism''' | * '''Definition of neurogenic lower urinary tract dysfunction (NLUTD): lower urinary tract dysfunction due to disturbance of the neurological control mechanism''' | ||
** This broad definition is used to describe a multitude of conditions of varying severity | ** This broad definition is used to describe a multitude of conditions of varying severity | ||
== | == Causes of NLUTD == | ||
* '''Neurological conditions commonly associated with LUT dysfunction (3):''' | * '''Neurological conditions commonly associated with LUT dysfunction (3):''' | ||
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== | == Risk classification for urological morbidity in NLUTD == | ||
{| class="wikitable" | {| class="wikitable" | ||
|'''Risk group''' | |'''Risk group''' | ||
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* '''Patients with SCI, spina bifida, or advanced MS without high-risk features are considered moderate-risk''' | * '''Patients with SCI, spina bifida, or advanced MS without high-risk features are considered moderate-risk''' | ||
===== ''' | == Genitourinary sequelae of NLUTD == | ||
===== '''(SUSU VIU)''' ===== | |||
# '''Sepsis''' | # '''Sepsis''' | ||
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*** Renal function decline can occur up to 45 years after injury | *** Renal function decline can occur up to 45 years after injury | ||
== | == Autonomic dysreflexia == | ||
* '''Typically occurs in patients with an injury at level T6 or above''' | * '''Typically occurs in patients with an injury at level T6 or above''' | ||
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** Recent data suggests that intravesical injection of onabotulintoxinA decreases the frequency and severity of AD episodes. | ** Recent data suggests that intravesical injection of onabotulintoxinA decreases the frequency and severity of AD episodes. | ||
== Diagnosis and Evaluation == | |||
* '''Mandatory in all patients (3): history and physical exam, urinalysis, PVR''' | * '''Mandatory in all patients (3): history and physical exam, urinalysis, PVR''' | ||
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* '''See Figure 2 from Original Guideline''' | * '''See Figure 2 from Original Guideline''' | ||
== | == Management of NLUTD == | ||
* '''The treating clinician should identify patients as either being high-, moderate-, or low-risk, offer the patient appropriate initial therapy, and consider a urological surveillance program as outlined below''' | * '''The treating clinician should identify patients as either being high-, moderate-, or low-risk, offer the patient appropriate initial therapy, and consider a urological surveillance program as outlined below''' | ||
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**** The bladder should be removed at the time of surgery to reduce the risks of pyocystis, chronic symptomatic cystitis, and malignancy | **** The bladder should be removed at the time of surgery to reduce the risks of pyocystis, chronic symptomatic cystitis, and malignancy | ||
== Surveillance studies for NLUTD patients in the community setting == | |||
{| class="wikitable" | {| class="wikitable" | ||
|'''Risk group''' | |'''Risk group''' | ||
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* We support the use of cystoscopy for the assessment of suspected urethral or bladder pathology. '''We do not support routine surveillance cystoscopy for bladder cancer screening in NLUTD with or without augmentation cystoplasty''' | * We support the use of cystoscopy for the assessment of suspected urethral or bladder pathology. '''We do not support routine surveillance cystoscopy for bladder cancer screening in NLUTD with or without augmentation cystoplasty''' | ||
== Questions == | |||
# List conditions associated with neurogenic lower urinary tract dysfunction. | # List conditions associated with neurogenic lower urinary tract dysfunction. | ||
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# What is the recommended surveillance in patients with NLUTD? | # What is the recommended surveillance in patients with NLUTD? | ||
== Answers == | |||
# List conditions associated with neurogenic lower urinary tract dysfunction. | # List conditions associated with neurogenic lower urinary tract dysfunction. | ||