title: Lower urinary tract symptoms following neurological illness may be influenced by multiple factors: observations from a neurorehabilitation service in a developing country.
abstract: OBJECTIVE
  To evaluate the pattern of lower urinary tract dysfunction (LUTD) in patients with neurological disease in the setting of a rehabilitation service in a developing country, and analyze causes for unexpected lower urinary tract symptoms (LUTS).
  
  
  METHODS
  Patients with neurological disorders and having significant LUTS were prospectively evaluated. Level of neurological lesion was localized by neurological examination and investigations. LUTD was evaluated by symptom analysis, bladder diaries and ultrasonography. Storage symptoms were managed using antimuscarinic medications and voiding dysfunction, when significant, was managed by catheterization and patients were regularly followed up. Patients with symptoms that had not been expected based upon their level of neurological lesion were further evaluated.
  
  
  RESULTS
  Fifty patients (mean age 43.5 +/- 18.3 years) were included and according to neurological localization, were categorized into suprapontine (n = 9; 18%), infrapontine/suprasacral (n = 25; 50%) or infrasacral (n = 16; 32%) groups. Incontinence was more common in patients with suprapontine and infrapontine/suprasacral lesions (n = 20) (P < 0.03), hesitancy more common with infrapontine/suprasacral lesions (n = 20) (P = 0.004) and retention more with infrasacral lesions (n = 13) (P < 0.001). Patients belonging to suprapontine and infrapontine/suprasacral groups more likely showed improvement at follow up (P = 0.008). Fourteen patients (28%) had unexpected LUTS and this was due to urological causes (n = 6) or multiaxial neurological involvement (n = 8). Potentially treatable factors were managed, resulting in symptom relief.
  
  
  CONCLUSIONS
  LUTS in neurological disease may be at variance with the pattern expected based upon level of neurological lesion. Such patients may require further evaluation and consideration should be given to concomitant urological conditions and multiaxial neurological involvement.
authors.affiliation: Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India. jaleshp@hotmail.com
authors.forename: Jalesh N
authors.initials: JN
authors.lastname: Panicker
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Menon
authors.forename: A
authors.initials: A
authors.lastname: Anandkumar
authors.forename: K R
authors.initials: KR
authors.lastname: Sundaram
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Fowler
mesh_terms: D000328:Adult; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D009422:Nervous System Diseases / Q000150:complications*; D011446:Prospective Studies; D014555:Urination Disorders / Q000175:diagnosis* / Q000209:etiology*