Page 1 - Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction – Executive Summary

CUA GUIDELINE

Canadian Urological Association guideline: Diagnosis, management,

and surveillance of neurogenic lower urinary tract dysfunction –

Executive summary

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,
Canada; Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada; Department of Urology, Dalhousie University, Halifax, NS, Canada; Division of Urology, Department
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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):156-65 http://dx.doi.org/10.5489/cuaj.6041 Prior neurogenic guidelines vary in their clinical assess-
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ment, investigations used, and surveillance strategies. The
Full text published online February 7, 2019; available at cuaj.ca 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
Introduction provide an approach to the management and surveillance
of patients with NLUTD.
Classification
Definitions/purpose
The etiology of a NLUTD is often classified based on wheth-
The term “neurogenic bladder” describes lower urinary tract er the primary lesion is suprapontine, suprasacral, sacral,
dysfunction that has occurred likely as a result of a neu - or infrasacral. A complementary system was developed by
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rological injury or disease. The International Continence Madersbacher et al based on the function of the detrusor
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Society (ICS) defines “neurogenic lower urinary tract dys- muscle and of the external sphincter. These systems allow
function” (NLUTD) as “lower urinary tract dysfunction due a physician to have a general idea of how the lower urinary
to disturbance of the neurologic control mechanism.” This tract is likely to behave in SCI patients with more complete
broad definition is used to describe a multitude of conditions injuries (Fig. 1). Newer systems using magnetic resonance
of varying severity. (MR) urography in combination with urodynamics (UDS)
Common causes of NLUTD include: spinal cord injury have also been proposed. 9
(SCI), multiple sclerosis (MS), and myelomeningocele (MMC).
Other causes of NLUTD include: Parkinson’s disease, cere- Methodology
brovascular accidents, traumatic brain injury, brain or spinal
cord tumour, cauda equina syndrome, transverse myelitis, This review was performed according to the methodology
multisystem atrophy, pelvic nerve injury, and diabetes. recommended by the Canadian Urological Association. 10
It is well-described that neurological disorders can lead to EmBASE and Medline databases were used to identify litera-
urological complications, including: urinary incontinence, ture relevant to the early urological care of NLUTD patients.
urinary tract infection (UTI), urolithiasis, sepsis, ureteric Recommendations were developed by consensus among the
obstruction, vesicoureteric reflux (VUR), and renal failure. 2 authors and graded using a modified Oxford system, which
Due to the potential morbidity, and even mortality, initial identifies level of evidence (LOE) and grade of recommen-
investigation, ongoing management, and surveillance is war- dation (GOR). For brevity, a complete version is included
ranted in this patient population. Despite the frequency and online (available at cuaj.ca); this executive summary focuses
potential severity of NLUTD, there are few high-quality stud- on recommendations from specific sections and the initial
ies in the literature to guide urological practices. evaluation and surveillance for patients with NLUTD.

156 CUAJ • June 2019 • Volume 13, Issue 6
© 2019 Canadian Urological Association