Evaluation and management of the urologic consequences of neurologic disease

Neurologic disorders create important functional urinary tract abnormalities. Loss of bladder reflex inhibition and coordination due to neurologic disease or injury to higher centers may lead to morbidity such as recurrent urinary tract infection, hydronephrosis, urinary tract stones and loss of renal function. This paper discusses neurogenic bladder disease using a descriptive urodynamic format. The importance of detrusor hyperreflexia and internal and external sphincter dyssynergia are discussed in detail. Finally, a practical clinical management plan is discussed for patients with urologic dysfunction due to cerebrovascular accident, Parkinson's disease, multiple sclerosis, spinal cord injury, and peripheral neuropathy.