Taiwanese Continence Society clinical guidelines for diagnosis and management of neurogenic lower urinary tract dysfunction

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

Research output: Contribution to journalReview article

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)35-41
Number of pages7
JournalUrological Science
Volume25
Issue number2
DOIs
Publication statusPublished - Jun 2014
Externally publishedYes

Keywords

  • Detrusor overactivity
  • Lower urinary tract dysfunction
  • Neurogenic bladder
  • Urological complication

ASJC Scopus subject areas

  • Urology

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  • Cite this

    Kuo, H. C., Chen, S. L., Chou, C. L., Chuang, Y. C., Huang, Y. H., Juan, Y. S., Lee, W. C., Liao, C. H., Tsai, Y. C., Tsai, Y. A., & Wang, C. C. (2014). Taiwanese Continence Society clinical guidelines for diagnosis and management of neurogenic lower urinary tract dysfunction. Urological Science, 25(2), 35-41. https://doi.org/10.1016/j.urols.2014.03.003