[Neuro-urological diagnosis and therapy of lower urinary tract dysfunction in patients with spinal cord injury : S2k Guideline of the German-Speaking Medical Society of Paraplegia (DMGP), AWMF register no. 179/001].
BACKGROUND
Most patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD), bowel dysfunction and sexual dysfunction. If these remain untreated, severe medical complications and serious limitations (restrictions) in quality of life are imminent.


OBJECTIVE
In the long term, there are considerable differences in the treatment results of highly specialized centers versus other treatment facilities.


METHODS
Against this background, a consensus-based guideline, according to the AWMF (Association of the Scientific Medical Societies in Germany) criteria (S2k), was developed by the neuro-urology working group of the DMPG (German-Speaking Medical Society of Paraplegia).


RESULTS
The guideline defines the principles and objectives of the neuro-urological care of patients with SCI and discusses in detail the principles of diagnosis and therapy of NLUTD. The need for video-urodynamic studies as a basis for the classification of the NLUTD and as a foundation for the development of a treatment strategy is emphasized. Both conservative and surgical therapy options and their indications are explained in detail. Possible complications and their prevention in the long-term course of SCI are presented with a particular consideration of the specific features of urinary tract infections and autonomic dysreflexia. Finally, the principles of the provision of urological appliances are discussed.


CONCLUSIONS
The presented S2k guideline provides the current standards in the neuro-urological care of patients with NLUTD due to SCI. Their consistent implementation both in the acute and chronic phase as well as in the context of lifelong surveillance of SCI patients should prevent the impending complications of NLUTD.
Abt. Neuro-Urologie, Querschnittgelähmtenzentrum, BG-Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Deutschland. r.boethig@bgk-hamburg.de.
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Böthig
Neurologische Rehabilitationsklinik, Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Deutschland.
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B
Domurath
Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH, Viersener Str. 450, 41063, Mönchengladbach, Deutschland.
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Kaufmann
Zentrum für Neuro-Rehabilitation, Querschnittgelähmten-Zentrum, BDH-Klinik Greifswald gGmbH, Karl-Liebknecht-Ring 26a, 17491, Greifswald, Deutschland.
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Bremer
Neurologische Rehabilitationsklinik, Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Deutschland.
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Vance
Querschnittgelähmten-Zentrum, Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Deutschland.
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Kurze
D003937:Diagnosis, Differential; D003943:Diagnostic Techniques, Neurological / Q000592:standards*; D003950:Diagnostic Techniques, Urological / Q000592:standards*; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D017410:Practice Guidelines as Topic; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis* / Q000209:etiology*; D014572:Urology / Q000592:standards*
AWMF guideline; Autonomic dysreflexia; Neurogenic lower urinary tract dysfunction due to spinal cord injury; Urinary incontinence; Urinary tract infection