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Clinical guidelines for the diagnosis and management of neurogenic lower urinary tract dysfunction

Hann-Chorng Kuoa, b, Sung-Lang Chenc, d, Chieh-Lung Choue, Yao-Chi Chuangf, Yu-Hui Huangd, g, Yung-Shun Juanh, i, j, Wei-Ching Leef, Chun-Hou Liaok, Yao-Chou Tsail, Yun-An Tsaim, Chung-Cheng Wangn, o

a Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
b Department of Urology, Tzu Chi University, Hualien, Taiwan
c Department of Urology, Chung-Shan Medical University Hospital, Taichung, Taiwan
d School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
e Department of Urology, China Medical University Hospital, Taichung, Taiwan
f Department of Urology, Kaohsiung Chang Gung Hospital and College of Medicine, Chang Gung University, Kaohsiung, Taiwan
g Department of Physical Medicine and Rehabilitation, Chung-Shan Medical University Hospital, Taichung, Taiwan
h Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
i Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
j Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
k Department of Urology, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
l Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
m Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
n Department of Urology, En Chu Kong Hospital, New Taipei, Taiwan
o College of Medicine, National Taiwan University, Taipei, Taiwan

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This article reports the current evidence and expert opinions on the diagnosis and management of neurogenic lower urinary tract dysfunction (NLUTD) in Taiwan. The main problems of NLUTD are failure to store, failure to empty, and a combination of these two. Priorities in the management of NLUTD, in order of importance, should be the following: (1) preservation of renal function; (2) freedom from urinary tract infection; (3) efficient bladder emptying; (4) freedom from indwelling catheters; (5) patient agreement with the management modality; and (6) avoidance of medication after proper management. Management of the urinary tract in patients with spinal cord injuries or multiple sclerosis must be based on urodynamic findings rather than on inferences from the neurological evaluation. Identification of high-risk patients is important to prevent renal functional impairment in those with chronic NLUTD. The lower urinary tract function of patients with NLUTD should be regularly followed up by urodynamic study, and any urological complication should be treated adequately. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Intravesical instillation of vanilloids and injecting botulinum toxin-A are alternative treatments for refractory detrusor overactivity or a low compliant bladder, and can replace the need for bladder augmentation. When surgical intervention is necessary, less invasive types of surgery and reversible procedures should be considered first, and any unnecessary surgery in the lower urinary tract should be avoided. Keeping the bladder and urethra in good condition without the interference of neuromuscular continuity provides patients with NLUTD the opportunity to use new technologies in the future. Improving the quality of life in patients with neurogenic voiding dysfunction is the most important aspect of treatment.

Detrusor overactivity; Lower urinary tract dysfunction; Neurogenic bladder; Urological complication


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