Improving the global management of the neurogenic bladder patient: part I. The complexity of patients.
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.
Denys
Pierre
P
Affiliation Hôpital Raymond Poincaré, Garches, France. pierre.denys@rcp.ap-hop-paris.fr
Corcos
Jacques
J
Everaert
Karel
K
Chartier-Kastler
Emmanuel
E
Fowler
Clare
C
Kalsi
Vinay
V
Nitti
Victor
V
Schulte-Baukloh
Heinrich
H
Schurch
Brigitte
B
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