Taiwanese Continence Society clinical guidelines for diagnosis and management of neurogenic lower urinary tract dysfunction |
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| Authors: | Hann-Chorng Kuo Sung-Lang Chen Chieh-Lung Chou Yao-Chi Chuang Yu-Hui Huang Yung-Shun Juan Wei-Ching Lee Chun-Hou Liao Yao-Chou Tsai Yun-An Tsai Chung-Cheng Wang |
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| Affiliation: | 1. Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan;2. Department of Urology, Chung-Shan Medical University Hospital, Taichung, Taiwan;3. School of Medicine, Chung-Shan Medical University, Taichung, Taiwan;4. Department of Urology, China Medical University Hospital, Taichung, Taiwan;5. Department of Urology, Kaohsiung Chang Gung Hospital and College of Medicine, Chang Gung University, Kaohsiung, Taiwan;6. Department of Physical Medicine and Rehabilitation, Chung-Shan Medical University Hospital, Taichung, Taiwan;7. Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan;8. Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;9. Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;10. Department of Urology, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan;11. Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan;12. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan;13. Department of Urology, En Chu Kong Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan |
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| Abstract: | This article reports the current evidence and expert opinions on diagnosis and management of neurogenic lower urinary tract dysfunction (NLUTD) in Taiwan. The main problems of NLUTD are failure to store, failure to empty, and combined failure to store and empty. The priority of management of NLUTD should follow the order of: (1) preservation of renal function; (2) freedom from urinary tract infection (UTI); (3) efficient bladder emptying; and (4) freedom from indwelling catheter, and patients' expectation of management should be respected. Management of the urinary tract in patients with spinal cord injury (SCI) or multiple sclerosis (MS) must be based on urodynamic findings, rather than inferences from the neurologic evaluation. Selecting high risk patients is important to prevent renal function impairment in patients with chronic NLUTD. Patients with NLUTD should be regularly followed up for their lower urinary tract dysfunction by urodynamic study and any urological complication should be adequately treated. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Antimuscarinic agents with clean intermittent catheterization (CIC) may reduce urological complications and improve quality of life (QoL) in patients with NLUTD. Intravesical injection of botulinum toxin A provides an alternative treatment for refractory detrusor overactivity (DO) or low compliant bladder and can replace the need for bladder augmentation. When surgical intervention is necessary, we should consider the least invasive type of surgery and reversible procedure first and avoid any unnecessary surgery of the lower urinary tract. Keeping the bladder and urethra in a good condition without interference of the neuromuscular continuity provides patients with NLUTD a chance for future new technologies. It is most important to never give up on improving the QoL in patients with NLUTD. |
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| Keywords: | detrusor overactivity lower urinary tract dysfunction neurogenic bladder urological complication |
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