CUA: Neurogenic Lower Urinary Tract Dysfunction (2019): Difference between revisions
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* 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 | * 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 | * The pathophysiology of CKD in neurogenic bladder is not well-understood | ||
* '''Potential risk factors for UUTD in NLUTD (5):''' | * '''<span style="color:#ff0000">Potential risk factors for UUTD in NLUTD (5):''' | ||
*# '''Bladder outlet obstruction''' | *# '''<span style="color:#ff0000">Bladder outlet obstruction''' | ||
*# '''Ureteric obstruction''' | *# '''<span style="color:#ff0000">Ureteric obstruction''' | ||
*# '''UTIs''' | *# '''<span style="color:#ff0000">UTIs''' | ||
*# '''Stones''' | *# '''<span style="color:#ff0000">Stones''' | ||
*# '''Persistent high intravesical pressures (most important)''' | *# '''<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'''. | *#* '''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. | *#** 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''' | *#* '''Symptoms of high intravesical pressure''' (e.g., leakage between CIC) '''are rarely present and UDS are required to properly identify it''' | ||
*#* '''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">Since VUR and hydroureteronephrosis may be manifestations of high bladder pressures in neurogenic bladder, treatment should focus first on ensuring low storage pressure.''' | ||
*#** '''Anti-reflux surgery or double-J ureteral stenting should be avoided in these cases.''' | *#** '''<span style="color:#ff0000">Anti-reflux surgery or double-J ureteral stenting should be avoided in these cases.''' | ||
* '''CIC is superior to chronic suprapubic or urethral catheterization for preserving bladder compliance''' | * '''<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 | ** 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 | * Overall, patients at higher risk of UUTD are SB, suprasacral SCI, and men with MS. Clinically stable MS patients have lower rates of UUTD | ||