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This article reports the current evidence and expert opinions on the diagnosis and management of neurogenic lower urinary tract dysfunction (NLUTD) in Taiwan. The main problems of NLUTD are failure to store, failure to empty, and a combination of these two. Priorities in the management of NLUTD, in order of importance, should be the following: (1) preservation of renal function; (2) freedom from urinary tract infection; (3) efficient bladder emptying; (4) freedom from indwelling catheters; (5) patient agreement with the management modality; and (6) avoidance of medication after proper management. Management of the urinary tract in patients with spinal cord injuries or multiple sclerosis must be based on urodynamic findings rather than on inferences from the neurological evaluation. Identification of high-risk patients is important to prevent renal functional impairment in those with chronic NLUTD. The lower urinary tract function of patients with NLUTD should be regularly followed up by urodynamic study, and any urological complication should be treated adequately. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Intravesical instillation of vanilloids and injecting botulinum toxin-A are alternative treatments for refractory detrusor overactivity or a low compliant bladder, and can replace the need for bladder augmentation. When surgical intervention is necessary, less invasive types of surgery and reversible procedures should be considered first, and any unnecessary surgery in the lower urinary tract should be avoided. Keeping the bladder and urethra in good condition without the interference of neuromuscular continuity provides patients with NLUTD the opportunity to use new technologies in the future. Improving the quality of life in patients with neurogenic voiding dysfunction is the most important aspect of treatment. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Neurogenic voiding dysfunction (NVD) results in lower urinary tract symptoms and upper urinary tract complications. Management of urinary tract dysfunction in patients with spinal cord injury (SCI) must be based on patient needs and urological complications. This study surveyed the bladder management and urological complications in patients with SCI in Taiwan. Materials and methods: A total of 894 patients with SCI were surveyed throughout Taiwan over a period of 5 years (2007–2011). All patients received neurological and urological examinations, renal sonography, bladder sonography, and urinalysis. They were further requested to report urinary tract infections (UTI), voiding conditions, and bladder management in the past 3 years. The bladder management and urological complications were analyzed based on different SCI levels and duration of disease. Results: Among all patients, 39.7% voided spontaneously or by reflex, 23.8% used percussion to void, 20.9% voided by abdominal pressure, 18.1% used clean intermittent catheterization (CIC), and 22.9% had indwelling catheters or cystostomy. Detrusor sphincter dyssynergia (DSD) was noted in 39.7% of patients and autonomic dysreflexia (AD) in 19.9%. UTI was noted in 483 (54%) patients, hydronephrosis in 110 (12.3%) patients, and severe urinary incontinence in 257 (28.7%) patients. UTI occurred significantly more often in patients without, than with normal voiding. CIC was more frequently used in patients with duration of SCI < 1 year, but the rate of CIC significantly decreased as the duration of SCI increased. Conclusion: The rates of urological complications in patients with chronic SCI remained high in this survey in Taiwan. Patients with a duration of SCI > 5 years chose indwelling catheters or a cystostomy more often than CIC. [Copyright &y& Elsevier]

Abstract: The main problems in neurogenic voiding dysfunction (NVD) are failure to store, failure to empty, and combined failure to store and empty. The management priorities in NVD should be as follows, in order: (1) preservation of renal function, (2) freedom from urinary tract infection, (3) efficient bladder emptying, (4) freedom from an indwelling catheter, (5) patient satisfaction with voiding management and (6) avoiding medication after proper management. Management of the urinary tract in patients with spinal cord injury must be based on urodynamic findings rather than inferences from a neurologic evaluation. Selecting high-risk patients is important to prevent renal function impairment in patients with chronic NVD. Patients with NVD should be regularly followed-up for lower urinary tract dysfunction using urodynamic study and any urological complication should be adequately treated. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Intravesical instillation of vanilloids or injection of BOTOX provides an alternative treatment for refractory detrusor overactivity or low compliant bladder and can replace the need for bladder augmentation. When surgical intervention is necessary, a less invasive type of surgery and a reversible procedure should be considered first and unnecessary surgery in the lower urinary tract should be avoided. Keeping the bladder and urethra in good condition without interfering with neuromuscular continuity will give patients with NVD a chance to benefit from new technologies in the future. It is most important that the physician continues to try to improve the quality of life of patients with NVD. [Tzu Chi Med J 2008;20(1):35–39] [Copyright &y& Elsevier]