Page 1 - Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction – Full text

CUA GUIDELINE

Canadian Urological Association guideline: Diagnosis, management,

and surveillance of neurogenic lower urinary tract dysfunction –

Full text

Alex Kavanagh, MD ; Richard Baverstock, MD ; Lysanne Campeau, MD ; Kevin Carlson, MD ;
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Ashley Cox, MD ; Duane Hickling, MD ; Genviève Nadeau, MD ; Lynn Stothers, MD ; Blayne Welk, MD 7*
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1 Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB,
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Canada; Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada; Department of Urology, Dalhousie University, Halifax, NS, Canada; Division of Urology, Department
of Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada; University of Western Ontario, London, ON, Canada
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*Guideline co-chairs
Cite as: Can Urol Assoc J 2019;13(6):E157-76. http://dx.doi.org/10.5489/cuaj.5912 primary reason is that there is limited evidence to support
a common strategy. The purpose of this guideline is to help
urologists to identify high-risk patients with NLUTD and to
Published online February 7, 2019 provide an approach to the management and surveillance
of patients with NLUTD.
Introduction Classification
The etiology of a NLUTD is often classified based on whether
Definitions/purpose the primary lesion is suprapontine, suprasacral, sacral, or
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infrasacral. A complementary system was developed by
The term “neurogenic bladder” describes lower urinary tract Madersbacher et al based on the function of the detrusor
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dysfunction that has occurred likely as a result of a neu- muscle and of the external sphincter. These systems allow
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rological injury or disease. The International Continence a physician to have a general idea of how the lower urinary
Society (ICS) defines “neurogenic lower urinary tract dys- tract is likely to behave in SCI patients with more complete
function” (NLUTD) as “lower urinary tract dysfunction due injuries (Fig. 1). Newer systems using magnetic resonance
to disturbance of the neurological control mechanism.” This (MR) urography in combination with urodynamics (UDS)
broad definition is used to describe a multitude of conditions have also been proposed. 9
of varying severity.
Common causes of NLUTD include: spinal cord injury Methodology
(SCI), multiple sclerosis (MS), and myelomeningocele (MMC).
Other causes of NLUTD include: Parkinson’s disease, cere- This review was performed according to the methodology
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brovascular accidents, traumatic brain injury, brain or spinal recommended by the Canadian Urologic Association.
cord tumour, cauda equina syndrome, transverse myelitis, EmBASE and Medline databases were used to identify
multisystem atrophy, pelvic nerve injury, and diabetes. literature relevant to the early urological care of NLUTD
It is well-described that neurological disorders can lead to patients. Given the limited literature in this area, no limits
urological complications, including: urinary incontinence, were placed on date or study design. Recommendations
urinary tract infections (UTIs), urolithiasis, sepsis, ureteric were developed by consensus and graded using a modi-
obstruction, vesicoureteric reflux (VUR), and renal failure. fied Oxford system, which identifies level of evidence (LOE)
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Due to the potential morbidity and even mortality, initial and grade of recommendation (GOR). This complete version
investigation, ongoing management, and surveillance is includes the full text of the guidelines (including the sections
warranted in this patient population. Despite the frequency in the Executive summary).
and potential severity of NLUTD, there are few high-quality We limited our guideline recommendations to adults with
studies in the literature to guide urological practices. NLUTD, although given the small body of literature for cer-
Prior neurogenic guidelines vary in their clinical assess- tain populations (such as spina bifida), relevant pediatric
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ment, investigations used, and surveillance strategies. The literature was considered if appropriate. Our initial in-person
CUAJ • June 2019 • Volume 13, Issue 6 E157
© 2019 Canadian Urological Association