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Neurogenic lower urinary tract dysfunction: how, when, and with which patients do we use urodynamics?
Teresa L Danforth1, David A Ginsberg2
1Department of Urology, SUNY Buffalo School of Medicine and Biomedical Sciences, Buffalo General Hospital, 100 High Street, Suite B280, Buffalo, NY 14203, USA.
The Urologic Clinics of North America
|July 27, 2014
Summary
Neurogenic lower urinary tract dysfunction (NLUTD) management focuses on monitoring and preventing upper tract disease. High detrusor leak point pressures indicate risk, necessitating tailored urodynamic study timing based on patient condition.
Area of Science:
- Urology
- Neuroscience
- Pediatrics
Background:
- Neurogenic lower urinary tract dysfunction (NLUTD) impacts numerous patients, demanding vigilant monitoring.
- Identifying patients at risk for upper tract disease is crucial for timely intervention.
Purpose of the Study:
- To highlight the importance of monitoring patients with NLUTD.
- To discuss the specific challenges and considerations for urodynamic studies in NLUTD patients.
- To emphasize the goals of managing NLUTD, including maintaining low bladder pressures, reducing infection risk, and preserving continence.
Main Methods:
- Review of initial studies on risk stratification for upper tract disease in NLUTD.
- Analysis of urodynamic study timing in different patient populations (acute injury, spinal dysraphism).
Main Results:
- High detrusor leak point pressures were identified as predictive of upper tract disease.
- Delayed urodynamics are recommended post-spinal shock in acute injury cases.
- Early urodynamics are advised for children with spinal dysraphism to assess risk.
Conclusions:
- Effective management of NLUTD requires careful monitoring and risk assessment.
- Urodynamic study protocols must be adapted to the specific clinical context of NLUTD patients.
- Achieving low bladder pressures, preventing infections, and maintaining continence are paramount in NLUTD care.
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