#0501

Management of the neurogenic lower urinary tract following spinal cord injury: A literature review

T. Milton¹, A. Couchman¹

¹Royal Adelaide Hospital, Department of Surgery, Adelaide, Australia

Introduction:

Spinal cord injuries commonly impact the complex neurological control of micturition leading to lower urinary tract dysfunction. It can present with lower urinary tract symptoms impacting quality of life, or sequela of incomplete emptying including renal impairment, stone formation, or recurrent infections. It can be classified by location of the injury, however the pattern of symptoms and urodynamics findings may not always directly correlate. Assessment involves a thorough history, examination, and investigations, including blood tests, upper tract imaging, bladder diary and urodynamics. Management and ongoing surveillance are tailored to the patient, taking in to account their injury, functional status and trajectory, symptoms and any coexisting bowel or sexual dysfunction. Intermittent catheterisation is the preferred bladder management strategy for incomplete emptying in suitable patients. Anticholinergics and Beta 3 agonists are used for symptoms of overactivity, or alternatively intravesical botulinum toxin injection has been used with high success rates. In select patients, sacral neuromodulation or more complex reconstructions including augmentation or diversion may be required. The overarching goals of treatment are to improve quality of life, maintain social continence, protect the upper tracts, and reduce the frequency and severity of infections. This requires a multidisciplinary team to tailor an individualised approach for each patient.

Material and methods:

A literature review was performed to determine current guidelines for management of neurogenic lower urinary tract dysfunction (NLUTD) following spinal cord injuries.

Results:

There is limited evidence-based guidelines for the management of NLUTD for patients with a spinal cord injury. There are guidelines available at EAU on NLUTD that can be extrapolated for the management of this population but do not address all the specific needs required.