title: Improving the global management of the neurogenic bladder patient: part I. The complexity of patients.
abstract: BACKGROUND
  The management of urinary incontinence in patients with neurological disease is complex. Physicians face a multitude of challenges related to progression of the primary condition, the presence of a diversity of other related and unrelated symptoms, the safety, efficacy and tolerability issues associated with multiple therapies being required and the changing need for collaboration with other specialities.
  
  
  METHODS
  Current guidelines produced by the urological communities, as well as the disease-focused organizations, aim to standardize care in their specific group of patients. A passive approach to implementation, however, means that guidelines produced are all too frequently not readily available to, read by or followed by the wider audience. In addition, each speciality has its own guidelines and a different view of the primary focus of care in neurological patients, which may lead to variations in recommendations and, subsequently, in clinical practice. A review of current urological and disease specific guidelines was made to evaluate differences between the published guidance between the specialities and within urology itself.
  
  
  CONCLUSIONS
  Although availability of effective therapies remains a cornerstone of neurogenic bladder treatment, consideration must also be given to the non-pharmacological and surgical issues related to the global management of this population. Improved cross-speciality interactions and development of patient-specific treatment and follow-up plans, which are in keeping with the current guidelines of each speciality involved, may serve to enhance physicians' understanding of the importance of effective urinary incontinence treatment as well as the overall management of the patient.
authors.affiliation: Affiliation Hôpital Raymond Poincaré, Garches, France. pierre.denys@rcp.ap-hop-paris.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Denys
authors.forename: Jacques
authors.initials: J
authors.lastname: Corcos
authors.forename: Karel
authors.initials: K
authors.lastname: Everaert
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
authors.forename: Clare
authors.initials: C
authors.lastname: Fowler
authors.forename: Vinay
authors.initials: V
authors.lastname: Kalsi
authors.forename: Victor
authors.initials: V
authors.lastname: Nitti
authors.forename: Heinrich
authors.initials: H
authors.lastname: Schulte-Baukloh
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schurch
mesh_terms: D005060:Europe; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000503:physiopathology; D014549:Urinary Incontinence