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Neurogenic bladder dysfunction.

H G Madersbacher1

  • 1Department of Neurology, Universitat Klinlken, Innsbruck, Austria.

Current Opinion in Urology
|August 25, 1999
PubMed
Summary

Urodynamics remain crucial for diagnosing and predicting neurogenic lower urinary tract dysfunction. Current treatments focus on pharmacotherapy for detrusor hyperreflexia, with ongoing research into surgical interventions.

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Area of Science:

  • Urology
  • Neurology
  • Rehabilitation Medicine

Background:

  • Neurogenic lower urinary tract dysfunction (NLUTD) diagnosis and management remain challenging.
  • Clinical investigations lack sensitivity, and advanced imaging like MRI has limitations in detecting spinal cord lesions.
  • Pharmacotherapy is the primary treatment for detrusor hyperreflexia, but further options are explored.

Purpose of the Study:

  • To review the current diagnostic and therapeutic strategies for neurogenic lower urinary tract dysfunction.
  • To evaluate the efficacy of various pharmacological and surgical interventions.
  • To highlight the ongoing challenges and future directions in managing NLUTD.

Main Methods:

  • Review of existing literature on urodynamics, clinical investigations, and advanced imaging for NLUTD.
  • Analysis of pharmacological treatments including tolterodine, oxybutynin, trospium chloride, propiverine, capsaicin, and intrathecal clonidine.
  • Evaluation of surgical options such as bladder augmentation, detrusor myectomy, sacral posterior root rhizotomy, and artificial sphincters.

Main Results:

  • Urodynamics are indispensable for NLUTD diagnosis and prognosis, surpassing clinical assessment and MRI.
  • Pharmacotherapy, particularly anticholinergics, remains central to managing detrusor hyperreflexia, with capsaicin and intrathecal clonidine showing promise.
  • Surgical interventions like bladder augmentation and detrusor myectomy offer favorable outcomes, while sacral posterior root rhizotomy effectively treats detrusor hyperreflexia in specific patient groups.
  • Collagen injections for neuropathic sphincter incompetence are not recommended; novel artificial sphincter designs require further validation.

Conclusions:

  • Urodynamics are essential and irreplaceable for diagnosing and managing neurogenic lower urinary tract dysfunction.
  • Pharmacological and surgical options continue to evolve, offering improved management for detrusor hyperreflexia and related conditions.
  • Further research is needed to refine treatments and develop innovative solutions for complex cases of NLUTD.

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