Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury

Abstract

The present article is an abridged English translation of the Japanese clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury updated as of July 2019. The patients are adult spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency‐volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of post‐void residual urine, uroflowmetry and video‐urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life.

Editorial Comment: Long-term effectiveness and complication rates of bladder augmentation in patients with neurogenic bladder dysfunction: A systematic review

“…International guidelines support a timely diagnosis and an individualized treatment to prevent upper and lower urinary tract deterioration in neuro-urological patients (1,2). Reconstructive surgery may be needed in high-risk patients, who failed conservative treatment for neurogenic detrusor overactivity (3).…”

Impact of clean intermittent catheterization on quality of life of patients with neurogenic lower urinary tract dysfunction due to radical hysterectomy: A cross‐sectional study

“…Clean intermittent catheterization (CIC) is a standard procedure for patients with neurogenic lower urinary tract dysfunction (NLUTD) who are unable to void spontaneously 1,2 . While the efficacy and safety of CIC have been frequently reported, 3,4 there have been few reports regarding differences in quality of life (QOL) between CIC and spontaneous voiding (SV) in patients with NLUTD, except patients with spinal cord injury (SCI) 5‐11 .…”

“…Patients who were undergoing adjuvant therapy (3) or significant therapeutic complications requiring interventions, such as symptomatic pelvic lymphocele (1), lymphedema (1), and ureteral stricture (1), were not included.…”

Editorial Comment to Urodynamic efficacy of fesoterodine for the treatment of neurogenic detrusor overactivity and/or low compliance bladder

“…These urodynamic effects translated into significant improvements in patients’ reported outcomes, as well as parameters from voiding diaries 1 . Anticholinergic drugs inhibit involuntary detrusor contraction and abnormal detrusor tonus, leading to increased bladder capacity and improved bladder compliance, which achieves a low‐pressure reservoir, and to control urinary incontinence 2 . This low‐pressure storage can prevent renal impairment and, in patients with intermittent catheterization, prolong the interval between catheterizations 2 .…”

“…Anticholinergic drugs inhibit involuntary detrusor contraction and abnormal detrusor tonus, leading to increased bladder capacity and improved bladder compliance, which achieves a low‐pressure reservoir, and to control urinary incontinence 2 . This low‐pressure storage can prevent renal impairment and, in patients with intermittent catheterization, prolong the interval between catheterizations 2 . However, there is a dearth of evidence of newer‐generation anticholinergics (imidafenacin, solifenacin and fesoterodine) for patients with neurogenic lower urinary tract dysfunction.…”