European Association of Urology

GUIDELINES ON NEUROGENIC LOWER URINARY TRACT DYSFUNCTION

M. Stöhrer, D. Castro-Diaz, E. Chartier-Kastler, G. Kramer, A. Mattiasson, J.J. Wyndaele

FEBRUARY 2003 TABLE OF CONTENTS PAGE

1. AIM AND STATUS OF THESE GUIDELINES 4 1.1 Purpose 4 1.2 Standardization 4 1.3 References 4

2. BACKGROUND 4 2.1 Risk factors and epidemiology 4 2.1.1 Peripheral neuropathy 4 2.1.2 Regional spinal anaesthesia 4 2.1.3 Iatrogenic 4 2.1.4 Demyelinisation (multiple sclerosis) 5 2.1.5 Dementia (Alzheimer, Binswanger, Nasu, Pick) 5 2.1.6 Basal ganglia pathology 5 2.1.7 Cerebrovascular pathology 5 2.1.8 Frontal brain tumours 5 2.1.9 Spinal cord lesions 5 2.1.10 Disc disease 5 2.2 Standardization of terminology 5 2.2.1 Introduction 5 2.2.2 Definitions 5 2.3 Classification 7 2.3.1 Introduction 7 2.3.2 Neuro-urologic classification 8 2.3.3 Neurologic classification 8 2.3.4 Urodynamic classification 8 2.3.5 Functional classification 8 2.3.6 Recommendation for classification 9 2.4 Timing of diagnosis and treatment 9 2.4.1 Guideline for timing of diagnosis and treatment 9 2.5 References 9

3. DIAGNOSIS 12 3.1 Introduction 12 3.2 History 12 3.2.1 General history 12 3.2.2 Specific history 12 3.2.3 Guidelines for history taking 13 3.3 Physical examination 13 3.3.1 General physical examination 13 3.3.2 Neuro-urologic examination 13 3.3.3 Laboratory tests 14 3.3.4 Guidelines for physical examination 14 3.4 Urodynamics 14 3.4.1 Introduction 14 3.4.2 Urodynamic tests 15 3.4.3 Specific uro-neurophysiologic tests 16 3.4.4 Guidelines for urodynamics and uro-neurophysiology 16 3.5 Typical manifestations of NLUTD 16 3.6 References 16

2 FEBRUARY 2003 4. TREATMENT 18 4.1 Introduction 18 4.2 Non-invasive conservative treatment 18 4.2.1 Assisted bladder emptying 18 4.2.2 Lower urinary tract rehabilitation 19 4.2.3 Drug treatment 19 4.2.4 Electrical neuromodulation 19 4.2.5 External appliances 20 4.2.6 Guidelines for non-invasive conservative treatment 20 4.3 Minimal invasive treatment 20 4.3.1 Catheterization 20 4.3.2 Guidelines for catheterization 20 4.3.3 Intravesical drug treatment 20 4.3.4 Intravesical electrostimulation 21 4.3.5 Bladder neck and urethral procedures 21 4.3.6 Guidelines for minimal invasive treatment 21 4.4 Surgical treatment 22 4.4.1 Urethral and bladder neck procedures 22 4.4.2 Detrusor myectomy (auto-augmentation) 22 4.4.3 Denervation. deafferentation, neurostimulation, neuromodulation 22 4.4.4 Bladder covering by striated muscle 23 4.4.5 Bladder augmentation or substitution 23 4.4.6 23 4.5 Guidelines for surgical treatment 24 4.6 References 24

5. TREATMENT OF VESICO-URETERAL REFLUX 36 5.1 Treatment options 36 5.2 References 36

6. QUALITY OF LIFE 37 6.1 Considerations 37 6.2 References 37

7. FOLLOW UP 38 7.1 Considerations 38 7.2 Guidelines for follow-up 38 7.3 References 38

8. CONCLUSION 39

9. ABBREVIATIONS 40

FEBRUARY 2003 3 1. AIM AND STATUS OF THESE GUIDELINES

1.1 Purpose The purpose of these clinical guidelines is to provide information on the incidence, definitions, diagnosis, therapy, and follow up observation of the condition of neurogenic lower urinary tract dysfunction (NLUTD), that will be useful for clinical practitioners. These guidelines reflect the current opinion of the experts in this specific pathology and thus represent a state of the art reference for all clinicians as of the date of its presentation to the European Association of Urology.

1.2 Standardization The terminology used and the diagnostic procedures advised throughout these guidelines follow the recommendations for investigations on the lower urinary tract (LUT) as published by the International Continence Society (ICS) (1-3).

1.3 References 1. Stöhrer M, Goepel M, Kondo A, Kramer G, Madersbacher H, Millard R, Rossier A, Wyndaele JJ. The standardization of terminology in neurogenic lower urinary tract dysfunction with suggestions for diagnostic procedures, Neurourol Urody