Neuro-Urology
"last update: 15 July 2024"
- Introduction, purpose, scope and audience
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Introduction. Neurological diseases are vast, and they may have adverse consequences on the urinary system. The extent and site of the neurological insult will determine the type of neurogenic lower urinary tract disease (NLUTD). The term “neurogenic bladder” describes lower urinary tract dysfunction that has occurred likely as a result of a neurological injury or disease (1) which may be in the central, autonomic or peripheral nervous systems. The International Continence Society (ICS) defines “Adult neurogenic lower urinary tract dysfunction" (ANLUTD) as abnormal or difficult function of the bladder, urethra (and/ or prostate in men) in mature individuals in the context of clinically confirmed relevant neurologic disorder (2). Neuro-urological disorders are classified according to Panicker et al. into (3): i. Suprapontine and pontine lesions (Upper motor neuron lesions = UMNL) ii. Spinal (Infrapontine and suprasacral) lesions (UMNL) iii. Sacral and infrasacral lesions (Lower motor neuron lesions = LMNL) The current classification systems serve as a framework since it is not possible to map all lesions and its consequences in every patient in a single classification (4). Most of these systems are of no use today such as: Lapides (1970), Bors and Comarr (1971)& Wein functional classification (1981). More recently, other classification systems were described according to pattern of clinical urological and urodynamic manifestations and aimed to predict site of neurologic affection. The most commonly used are The Madersbacher system and the system described by Panicker et al. The worst complication of NLUTD is upper urinary tract (UUT) deterioration, which is the leading cause of morbidity and mortality in this subset of patients. UUT deterioration is more with spinal cord injury (SCI) and spine bifida (SB) patients. It is very crucial to stratify NLUTD patients into high and low risk groups and their lesions according into upper and lower motor neuron lesions, to individualize the plan of management and follow up thus preventing further deterioration and complications. Therefore, early diagnosis (Figure 1), treatment (Figure 2) and follow-up of these patients are crucial. The main goals of management for NLUTD are satisfaction and avoidance of adverse outcomes which includes (5,6): • Protecting upper urinary tract from sustained high filling and voiding pressures (Pdet >40 cmH2O). • Achieving regular bladder emptying, avoiding stasis and bladder over distension, and minimizing PVR to less than 100mls. • Preventing and treating complications such as UTIs, stones, strictures and AD • Achievement (or maintenance) of urinary continence (Social goal). • Restoration of LUT function (Adequate storage and emptying at low intravesical pressure). • Improvement of the patient’s QoL. The time interval between initial investigations and control diagnostics should not exceed one to two years. In high-risk neuro-urological patients, this interval should be much shorter. Purpose. The Urologic Egyptian Guidelines on Neuro-Urology aim to help and guide clinical practitioners to have knowledge of the incidence, standard definitions, diagnosis, therapy, and follow-up of NLUTD. This document integrates recent international guidelines with local experts’ opinions based on Egyptian healthcare and socioeconomic circumstances. It also reflects the opinions of experts in Neuro-Urology and represents state-of-the art references for all clinicians, as of the publication date Target Audience. ▪️ Urologists▪️ Gynecologists ▪️ Neurologists and Neurosurgeons ▪️ General Practitioners |
