Clinical Guidelines of Patient-Centered Bladder Management of Neurogenic Lower Urinary Tract Dysfunction Due to Chronic Spinal Cord Injury - Part 3: Surgical Treatment in Chronic Spinal Cord Injured Patients
Journal
Urological Science
Journal Volume
34
Journal Issue
3
Date Issued
2023-07-01
Author(s)
Lin, Yu Hua
Fan, Yu Hua
Wu, Chun Te
Shen, Yuan Chi
Hu, Ju Chuan
Chang, Po Chih
Liao, Chun Hou
Chen, Yu Chen
Lin, Victor Chia Hsiang
Hsu, Chih Chen
Wang, Chung Cheng
Lin, Wei Yu
Lin, Chih Chieh
Jiang, Yuan Hong
Kuo, Hann Chorng
Abstract
This article reports the current evidence and expert opinions on patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among chronic spinal cord injured (SCI) patients in Taiwan. The main problems with SCI-NLUTD are failure to store, empty, or both. The management of SCTNLUTD should be prioritized as follows: (a) preservation of renal function, (b) freedom from urinary tract infection, (c) efficient bladder emptying, (d) freedom from indwelling catheters, (e) patient agreement with management, and (f) avoidance of medication after proper management. The management of NLUTD in SCI patients must be based on urodynamic findings rather than neurologic evaluation inferences. It is important to identify high-risk patients to prevent renal functional deterioration in those with chronic SCI-NLUTD. Urodynamic studies should be performed on patients with SCI on a regular basis, and any urological complications should be adequately treated. When surgery is required, less invasive and reversible procedures should be considered first, and any unnecessary surgery in the lower urinary tract should be avoided. The most important aspect of treatment is to improve the quality of life in SCI patients with NLUTD. Annual active surveillance of bladder and renal function is required to avoid renal function deterioration and urological complications, particularly in high-risk SCI patients.
Subjects
Bladder management | guidelines | lower urinary tract dysfunction | neurogenic bladder | spinal cord injury | surgery
Type
other