title: Lower urinary tract dysfunction in the neurological patient: clinical assessment and management.
abstract: Lower urinary tract (LUT) dysfunction is a common sequela of neurological disease, resulting in symptoms that have a pronounced effect on quality of life. The site and nature of the neurological lesion affect the pattern of dysfunction. The risk of developing upper urinary tract damage and renal failure is much lower in patients with slowly progressive non-traumatic neurological disorders than in those with spinal cord injury or spina bifida; this difference in morbidity is taken into account in the development of appropriate management algorithms. Clinical assessment might include tests such as uroflowmetry, post-void residual volume measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the indication. Incomplete bladder emptying is most often managed by intermittent catheterisation, and storage dysfunction by antimuscarinic drugs. Intradetrusor injections of onabotulinumtoxinA have transformed the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. An individualised, patient-tailored approach is required for the management of LUT dysfunction associated with neurological disorders.
authors.affiliation: Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK. Electronic address: j.panicker@ucl.ac.uk.
authors.forename: Jalesh N
authors.initials: JN
authors.lastname: Panicker
authors.affiliation: Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK.
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Fowler
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
mesh_terms: D000328:Adult; D019468:Disease Management; D005260:Female; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D009422:Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013904:Thoracic Vertebrae; D014551:Urinary Tract / Q000294:innervation / Q000503:physiopathology; D014570:Urologic Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy