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Paraplegia with neurogenic urinary bladder — Clinical Guidelines

Overview

Neurogenic bladder with paraplegia results from neurological damage affecting bladder control, leading to symptoms such as urinary retention, incontinence, and increased risk of urinary tract infections and renal impairment 1 5 9.

Diagnosis

Key Symptoms: Urinary frequency, urgency, incontinence, retention, and recurrent infections 1 5.

Recommended Tests: Urodynamic studies (cystometry, pressure-flow studies), renal function tests, and imaging (ultrasound, MRI) to assess bladder capacity and function 5.

Grading: Use urodynamic findings to classify severity (e.g., detrusor overactivity, detrusor underactivity, sphincter dyssynergia) 5.

Management

First-Line Treatments:

- Clean Intermittent Catheterization (CIC): For managing retention and preventing infections 1 30. - Anticholinergic Agents: For overactive detrusor (e.g., tolterodine, oxybutynin) 3. - Botulinum Toxin Injections: For refractory detrusor overactivity and sphincter dyssynergia 21.

Adjunctive Treatments:

- Augmentation Cystoplasty: For severe refractory cases, increasing bladder capacity 7. - Enterocystoplasty: Using segments of bowel to augment bladder capacity 18. - Sphincterotomy: For relief of outlet obstruction 32.

Special Populations

Pediatrics: Early evaluation and management to prevent renal damage; clean intermittent catheterization is effective 9.

Elderly: Focus on minimizing complications like UTIs and ensuring proper catheter care 1.

Comorbidities: Tailor management considering coexisting conditions like diabetes, which may affect bladder control and infection risk 1 5.

Key Recommendations

Regular Urodynamic Assessment: Monitor bladder function and adjust management strategies accordingly (Evidence: Moderate 5).

Prompt Referral to Urology: For refractory symptoms or safety concerns to ensure appropriate intervention (Evidence: Expert opinion 1).

Use of Clean Intermittent Catheterization: Effective for managing retention and preventing complications in neurogenic bladder (Evidence: Moderate 30).

Consider Botulinum Toxin Injections: For patients with refractory overactive bladder symptoms (Evidence: Weak 21).

Follow Guidelines for Preventive Care: Implement preventive measures as outlined in clinical guidelines to optimize outcomes (Evidence: Moderate 19).

References

1 Atiemo HO, Stoffel JT. A Primer for Primary Care Physicians Managing Neurogenic Bladder Patients. The Urologic clinics of North America 2024. link 2 Fendereski K, Hebert KJ, Matta R, Myers JB. Variation in Provider Practice Patterns and the Perceived Need for a Shared Decision-making Tool for Neurogenic Lower Urinary Tract Dysfunction. Urology 2023. link 3 Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D et al.. Efficacy of overactive neurogenic bladder treatment: A systematic review of randomized controlled trials. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica 2022. link 4 Chua ME, Tse LN, Silangcruz JM, Kim JK, Dos Santos J, Varghese A et al.. Scoping review of neurogenic bladder patient-reported readiness and experience following care in a transitional urology clinic. Neurourology and urodynamics 2022. link 5 Ginsberg DA, Boone TB, Cameron AP, Gousse A, Kaufman MR, Keays E et al.. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation. The Journal of urology 2021. link 6 Ginsberg DA, Boone TB, Cameron AP, Gousse A, Kaufman MR, Keays E et al.. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-up. The Journal of urology 2021. link 7 Taghavi K, O'Hagan LA, Bortagaray J, Bouty A, M Hutson J, O'Brien M. Complication profile of augmentation cystoplasty in contemporary paediatric urology: a 20-year review. ANZ journal of surgery 2021. link 8 Huri E, Hamid R. Technology-based management of neurourology patients in the COVID-19 pandemic: Is this the future? A report from the International Continence Society (ICS) institute. Neurourology and urodynamics 2020. link 9 Le HK, Cardona-Grau D, Chiang G. Evaluation and Long-term Management of Neurogenic Bladder in Spinal Dysraphism. NeoReviews 2019. link 10 Gajewski JB, Schurch B, Hamid R, Averbeck M, Sakakibara R, Agrò EF et al.. An International Continence Society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD). Neurourology and urodynamics 2018. link 11 Jaggi A, Drake M, Siddiqui E, Fatoye F. A comparison of the treatment recommendations for neurogenic lower urinary tract dysfunction in the national institute for health and care excellence, European Association of Urology and international consultations on incontinence guidelines. Neurourology and urodynamics 2018. link 12 Shalaby MS, Gibson A, Granitsiotis P, Conn G, Cascio S. Assessment of the introduction of an adolescent transition urology clinic using a validated questionnaire. Journal of pediatric urology 2015. link 13 Rognoni C, Fizzotti G, Pistarini C, Mazzoleni MC. E-learning for neurological bladder management. Studies in health technology and informatics 2012. link 14 Stamatiou K, Tyritzis S, Karakos C, Skolarikos A. Urofacial syndrome: a subset of neurogenic bladder dysfunction syndromes?. Urology 2011. link 15 Al-Hayek S, Abrams P. The 50-year history of the ice water test in urology. The Journal of urology 2010. link 16 Wyndaele JJ, Kovindha A, Madersbacher H, Radziszewski P, Ruffion A, Schurch B et al.. Neurologic urinary incontinence. Neurourology and urodynamics 2010. link 17 Roth CC, Kropp BP. Recent advances in urologic tissue engineering. Current urology reports 2009. link 18 Al-Othman KE, Al-Hellow HA, Al-Zahrani HM, Seyam RM. Robotic augmentation enterocystoplasty. Journal of endourology 2008. link 19 Rikken B, Blok BF. Management of neurogenic bladder patients in The Netherlands: do urologists follow guidelines?. Neurourology and urodynamics 2008. link 20 Blok BF, Karsenty G, Corcos J. Urological surveillance and management of patients with neurogenic bladder: Results of a survey among practicing urologists in Canada. The Canadian journal of urology 2006. link 21 Jost WH, Naumann M. Botulinum toxin in neuro-urological disorders. Movement disorders : official journal of the Movement Disorder Society 2004. link 22 Perkash I. Donald Munro Lecture 2003. Neurogenic bladder: past, present, and future. The journal of spinal cord medicine 2004. link 23 Bardsley A. The neurogenic bladder. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2000. link 24 Joseph AC. The challenge of developing the nursing clinical practice guideline: neurogenic bladder management. Urologic nursing 1999. link 25 Dasgupta P, Haslam C, Goodwin R, Fowler CJ. The 'Queen Square bladder stimulator': a device for assisting emptying of the neurogenic bladder. British journal of urology 1997. link 26 Mouriquand PD, Sheard R, Phillips N, White J, Sharma S, Vandeberg C. The Kropp-onlay procedure (Pippi Salle procedure): a simplification of the technique of urethral lengthening. Preliminary results in eight patients. British journal of urology 1995. link 27 Vorstman B, Schlossberg S, Kass L. Investigations on urinary bladder reinnervation. Historical perspective and review. Urology 1987. link90168-3) 28 Walter S, Olesen KP, Nordling J, Andersen JT, Meyhoff HH, Hald T. Neurogenic bladder. Acta obstetricia et gynecologica Scandinavica 1980. link 29 Schillinger JF, Toguri AG, Cant J, Cochrane G. Glans condom drainage system. Urology 1978. link90164-4) 30 Hasham AI, Uehling D. Unsterile intermittent catheterization for meningomyelocele. Southern medical journal 1977. link 31 Bradley WE, Timm GW. Combined electromyographic and gas urethral pressure profilometry. The Journal of urology 1976. link59230-7) 32 Hachen HJ, Ott R. Late results of bilateral endoscopic sphincterotomy in patients with upper motor neurone lesions. Paraplegia 1976. link 33 Schoenberg HW, Schoenberg MP, Gregory JG. Anterior bladder tube for continence in neurogenic bladder. Experimental study. Urology 1975. link90348-9) 34 Smith RB. Use of ileocystoplasty in the hypertonic neurogenic bladder. The Journal of urology 1975. link59424-0)

Paraplegia with neurogenic urinary bladder