Neurogenic Lower Urinary Tract Dysfunction in Adults with Cerebral Palsy: Outcomes following a Conservative Management Approach.
OBJECTIVE
Cerebral palsy is characterized by motor impairment following injury to the developing brain. Neurogenic lower urinary tract dysfunction is estimated to affect at least a third of children with cerebral palsy. However there are limited data as patients transition to adulthood. We sought to describe the symptoms, sequelae and management of neurogenic lower urinary tract dysfunction in adults with cerebral palsy.


METHODS
We retrospectively reviewed the charts of adult patients with cerebral palsy between 2011 and 2014. Patients with prior bladder reconstruction or catheterization based bladder drainage were excluded from study. Cerebral palsy severity was determined using GMFCS (Gross Motor Function Classification System). A conservative evaluation and treatment paradigm was used. Noninvasive treatments were encouraged. Specifically clean intermittent catheterization, which is often not feasible, is avoided unless urinary retention, hydronephrosis or refractory lower urinary tract symptoms develop.


RESULTS
There were 121 patients included in final analysis. Median age was 25 and 61 patients (50%) had GMFCS level V. Noninvasive management failed in 28 of 121 patients (23%) as defined by hydronephrosis in 9, persistent urinary retention in 10 and refractory lower urinary tract symptoms/incontinence in 9. Urethral clean intermittent catheterization was poorly tolerated. Of all patients 25% showed evidence of urolithiasis during the study period. Surgical intervention was rare and associated with significant morbidity.


CONCLUSIONS
Adults with cerebral palsy may present with variable signs and symptoms of neurogenic lower urinary tract dysfunction. Conservative treatment was successful in more than 75% of patients. Clean intermittent catheterization was poorly tolerated in patients in whom conservative treatment failed. Surgical intervention was rarely indicated and it should be reserved for select individuals.
Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Robert A
RA
Goldfarb
Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Andrew
A
Pisansky
Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Joseph
J
Fleck
Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Patrick
P
Hoversten
Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Katherine J
KJ
Cotter
Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Jenna
J
Katorski
Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Daniel
D
Liberman
Department of Urology, University of Minnesota, Minneapolis, Minnesota. Electronic address: selliott@umn.edu.
Sean P
SP
Elliott
D000328:Adult; D002547:Cerebral Palsy / Q000150:complications*; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology* / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000628:therapy*
adult; catheterization; cerebral palsy; treatment failure; urinary bladder, neurogenic