CUA: Neurogenic Lower Urinary Tract Dysfunction (2019): Difference between revisions
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*#** There is very limited data supporting the use of mirabegron in NLUTD | *#** There is very limited data supporting the use of mirabegron in NLUTD | ||
=== | === Intravesical therapy (2): === | ||
*'''Botox and oxybutynin''' | *'''Botox and oxybutynin''' | ||
*# '''Botox''' | *# '''Botox''' | ||
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*#* '''This approach avoids systemic side effects compared to oral oxybutynin''' | *#* '''This approach avoids systemic side effects compared to oral oxybutynin''' | ||
=== | === Neural stimulation and neuromodulation therapy === | ||
* '''Current data supporting the use of sacral neuromodulation (SNM) and peripheral tibial nerve stimulation (PTNS) are limited'''; remains unclear which subgroups of neurogenic voiding dysfunction and which underlying neurological disease will respond best to these different therapies. | * '''Current data supporting the use of sacral neuromodulation (SNM) and peripheral tibial nerve stimulation (PTNS) are limited'''; remains unclear which subgroups of neurogenic voiding dysfunction and which underlying neurological disease will respond best to these different therapies. | ||
*# '''SNM could be considered for the treatment of NDO or non-obstructive urinary retention in carefully selected individuals with NLUTD, as it can be a safe and effective option'''. It should be preceded by an adequate testing phase and may not be a good alternative to decrease detrusor pressures or improve bladder compliance. | *# '''SNM could be considered for the treatment of NDO or non-obstructive urinary retention in carefully selected individuals with NLUTD, as it can be a safe and effective option'''. It should be preceded by an adequate testing phase and may not be a good alternative to decrease detrusor pressures or improve bladder compliance. | ||
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* '''Dorsal rhizotomy (sacral deafferentation S2-S4/5) and sacral anterior root stimulation by an implantable device can achieve safe storage detrusor pressure and voluntary emptying of bladder and bowel in patients with complete SCI.''' '''Furthermore, it diminishes autonomic dysreflexia.''' This technique has good variable success rates in specialized centres, but comes with long-term complications and a very high rate of surgical revisions | * '''Dorsal rhizotomy (sacral deafferentation S2-S4/5) and sacral anterior root stimulation by an implantable device can achieve safe storage detrusor pressure and voluntary emptying of bladder and bowel in patients with complete SCI.''' '''Furthermore, it diminishes autonomic dysreflexia.''' This technique has good variable success rates in specialized centres, but comes with long-term complications and a very high rate of surgical revisions | ||
=== | === Surgical management of LUTD === | ||
* '''Indicated when conservative measures, medical therapy, and minimally invasive interventions alone fail to achieve the objectives of:''' | * '''Indicated 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 | *# Protecting kidney function and mitigating autonomic dysreflexia by maintaining bladder storage at safely low pressures | ||