Guidelines onNeurogenicLowerUrinary TractDysfunction

M. Stöhrer, B. Blok, D. Castro-Diaz, E. Chartier-Kastler,G. Del Popolo, G. Kramer, J. Pannek, P. Radziszewski, J-J. Wyndaele

© European Association of Urology 2010Table of ConTenTs Page1. AIM AND STATUS OF THESE GUIDELINES 4 1.1 Purpose 4 1.2 Standardization 4 1.3 References 4

2. BACKGROUND 4 2.1 Risk factors and epidemiology 4 2.1.1 Brain tumours 4 2.1.2 Dementia 4 2.1.3 Mental retardation 5 2.1.4 Cerebral palsy 5 2.1.5 Normal pressure hydrocephalus 5 2.1.6 Basal ganglia pathology (Parkinson’s disease, Huntington’s disease, 5 Shy-Drager syndrome, etc) 2.1.7 Cerebrovascular (CVA) pathology 5 2.1.8 Demyelinization 5 2.1.9 Spinal cord lesions 5 2.1.10 Disc disease 5 2.1.11 Spinal stenosis and spine surgery 5 2.1.12 Peripheral neuropathy 6 2.1.13 Other conditions (SLE) 6 2.1.14 HIV 6 2.1.15 Regional spinal anaesthesia 6 2.1.16 Iatrogenic 6 2.2 Standardization of terminology 6 2.2.1 Introduction 6 2.2.2 Definitions 7 2.3 Classification 9 2.3.1 Recommendation for clinical practice 10 2.4 Timing of diagnosis and treatment 10 2.5 References 10

3. DIAGNOSIS 17 3.1 Introduction 17 3.2 History 17 3.2.1 General history 17 3.2.2 Specific history 18 3.2.3 Guidelines for history taking 18 3.3 Physical examination 19 3.3.1 General physical examination 19 3.3.2 Neuro-urological examination 19 3.3.3 Essential investigations 21 3.3.4 Guidelines for physical examination 21 3.4 Urodynamics 21 3.4.1 Introduction 21 3.4.2 Urodynamic tests 21 3.4.3 Specific uro-neurophysiological tests 22 3.4.4 Guidelines for urodynamics and uro-neurophysiology 23 3.5 Typical manifestations of NLUTD 23 3.6 References 23

4. TREATMENT 25 4.1 Introduction 25 4.2 Non-invasive conservative treatment 26 4.2.1 Assisted bladder emptying 26 4.2.2 Lower urinary tract rehabilitation 26 4.2.3 Drug treatment 26

2 UPDATE MARCH 2008 4.2.4 Electrical neuromodulation 27 4.2.5 External appliances 27 4.2.6 Guidelines for non-invasive conservative treatment 27 4.3 Minimal invasive treatment 28 4.3.1 Catheterization 28 4.3.2 Guidelines for catheterization 28 4.3.3 Intravesical drug treatment 28 4.3.4 Intravesical electrostimulation 28 4.3.5 Botulinum toxin injections in the bladder 28 4.3.6 Bladder neck and urethral procedures 29 4.3.7 Guidelines for minimal invasive treatment 29 4.4 Surgical treatment 29 4.4.1 Urethral and bladder neck procedures 29 4.4.2 Detrusor myectomy (auto-augmentation) 30 4.4.3 Denervation, deafferentation, neurostimulation, neuromodulation 30 4.4.4 Bladder covering by striated muscle 30 4.4.5 Bladder augmentation or substitution 30 4.4.6 Urinary diversion 31 4.5 Guidelines for surgical treatment 31 4.6 References 32

5. TREATMENT OF VESICO-URETERAL REFLUX 46 5.1 Treatment options 46 5.2 References 47

6. QUALITY OF LIFE 47 6.1 Introduction 47 6.2 Conclusions and recommendations 48 6.3 References 48

7. FOLLOW UP 48 7.1 Introduction 48 7.2 Guidelines for follow-up 49 7.3 References 49

8. CONCLUSIONS 50 9. ABBREVIATIONS USED IN THE TEXT 51

UPDATE MARCH 2008 31. aIM anD sTaTUs of THese gUIDelInes1.1 PurposeThe purpose of these clinical guidelines is to provide useful information for clinical practitioners on the incidence, definitions, diagnosis, therapy, and follow-up observation of the condition of neurogenic lower urinary tract dysfunction (NLUTD). These guidelines reflect the current opinion of the experts in this specific pathology and thus represent a state-of-the-art reference for all clinicians, as of the date of its presentation to the European Association of Urology.

1.2 standardizationThe terminology used and the diagnostic procedures advised throughout these guidelines follow the recommendations for investigations on the lower urinary tract (LUT) as published by the International Continence Society (ICS) (1-3).

1.3 RefeRenCes1. Stöhrer M, Goepel M, Kondo A, Kramer G, Madersbacher H, Millard R, Rossier A, Wyndaele JJ. The standardization of terminology in neurogenic lower urinary tract dysfunction with suggestions for diagnostic procedures. International Continence Society Standardization Committee. Neurourol Urodyn 1999;18(2):139-58.http://www.ncbi.nlm.nih.gov/pubmed/100819532. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A. The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002;21(2):167-78.http://www.ncbi.nlm.nih.gov/pubmed/118576713. Schäfer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A, Sterling AM, Zinner NR, van Kerrebroeck P; International Continence Society. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow Studies. Neurourol Urodyn 2002;21(3):261-74.http://www.ncbi.nlm.nih.gov/pubmed/11948720