With time bladder management with clean intermittent catheterization has increased in popularity. However, only 20% of patients initially on clean intermittent catheterization remained on this form of bladder management. More research on the safety of each of these methods needs to be performed to provide better guidance to aid with this decision.

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Purpose To describe and compare the frequency and type of lower urinary tract symptoms (LUTS) reported by men and women at the time they were recruited from urology and urogynecology clinics into the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) multi-center, prospective, observational cohort study. Materials and Methods Six research sites enrolled treatment-seeking men and women who reported any LUTS at a frequency more than “rarely” during the past month on the LUTS tool. At baseline, study participants underwent a standardized clinical evaluation and completed validated questionnaires; urological tests were performed, including pelvic/rectal examination, post-void residual, and urinalysis. Results A total of 545 women and 519 men were enrolled. The mean age was 58.8 ± 14.1 years. At baseline, nocturia, frequency, and a sensation of incomplete emptying were similar between men and women, whereas men experienced more voiding symptoms (90% vs. 85%, p=0.007), and women reported more urgency (85% vs. 66%, p<0.001). Women also reported more urinary incontinence (any type) than men (82% vs. 51% p<0.001), which was predominantly mixed incontinence (57%). Men rarely reported stress incontinence (1%), but did have other urinary incontinence (44% post-void dribbling) or urgency incontinence (46%). Older participants had higher odds of reporting symptoms of nocturia and urgency. Conclusion In this large treatment-seeking cohort of men and women, LUTS varied widely by sex and age. Men reported more voiding symptoms and non-stress or urgency urinary incontinence, whereas women reported more incontinence overall and urgency. Older participants had greater odds of urgency and nocturia.

Based on this review no definitive recommendations for screening can be made except routine renal ultrasound. Urodynamics are an important part of screening but the frequency is unclear. The optimum bladder cancer screening method has not been defined.

Purpose Little is known about outcomes of sacral neuromodulation (SNM) in the general community, with published reports to date limited to case series or randomized controlled trials. The goal of this analysis was to identify the national SNM test phase success rate, and to identify patient factors that contribute to success. Materials and Methods Medical claims data were obtained from a 5% sample of Medicare beneficiaries (1997 to 2007), and from employees of 25 large (Fortune 500) companies (Ingenix, Inc – 2002-2007). Utilizing billing codes for the SMN procedure, success was defined as progressing from test phase (percutaneous or staged) to battery implantation. The rate of success was compared based on age, race, gender and diagnosis. Results In the Medicare sample, there were 358 patients who received percutaneous test stimulation and 1132 who underwent 2-stage lead placement. Of these, 45.8% of the percutaneous tests and 35.4% of the staged procedures underwent subsequent battery implantation. In the privately insured sample, there were 266 percutaneous procedures and 794 two-staged procedures. Percutaneous procedures were followed by battery placement in 24.1% of cases, whereas 50.9% of the staged procedures resulted in a battery implant. Gender was the only consistent predictor of success, with female patients demonstrating higher success rates in both datasets. Conclusion The SNM success rates in these datasets are inferior to those published in case series and small randomized controlled trials. Women had significantly better results than men, and privately insured individuals had better results than Medicare, indicating a potential age effect.

The clinician treating patients with neurogenic lower urinary tract dysfunction (NLUTD) needs to balance a variety of factors when making treatment decisions. In addition to the patient's urologic symptoms and urodynamic findings, other issues that may influence management options of the lower urinary tract include cognition, hand function, type of neurologic disease, mobility, bowel function/management, and social and caregiver support. This Guideline allows the clinician to understand the options available to treat patients, understand the findings that can be seen in NLUTD, and appreciate which options are best for each individual patient. This allows for decisions to be made with the patient, in a shared decision-making manner, such that the patient's quality of life can be optimized with respect to their bladder management. Materials and Methods: A comprehensive search for studies assessing patients undergoing evaluation, surveillance, management, or follow-up for NLUTD was conducted from January 2001 through October 2017 and was rerun in February 2021 to capture newer literature. The primary search returned 20,496 unique citations. Following a title and abstract screen, full texts were obtained for 3,036 studies. During full-text review, studies were primarily excluded for not meeting the PICO criteria. One hundred eight-four primary literature studies met the inclusion criteria and were included in the evidence base. Results: This guideline was developed to inform clinicians on the proper evaluation, diagnosis, and risk stratification of patients with NLUTD and the nonsurgical and surgical treatment options available. Additional statements on urinary tract infection and autonomic dysreflexia were developed to guide the clinician. This Guideline is for adult patients with NLUTD and pediatric NLUTD will not be discussed. Conclusions: NLUTD patients should be risk-stratified as either low-, moderate-, high-, or unknown-risk. After diagnosis and stratification, patients should be monitored according to their level of risk at regular intervals. Patients who experience new or worsening signs and symptoms should be reevaluated and risk stratification should be repeated.

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The Joint SIU-ICUD (Société Internationale d'Urologie) (International Consultation on Urological Diseases) International Consultation reviewed the available presented data and provided specific conclusions and recommendations for each non-surgical urologic method to address neurogenic bladder after SCI.