International Guidelines of Neurogenic Lower Urinary Tract Dysfunction

Abstract

Guidelines regarding neurogenic lower urinary tract dysfunction have been put forth by urologic associations and other clinical advisory systems throughout the world. The major European, American, and international guidelines including those of the European Association of Urology, National Institute for Health and Care Excellence, American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, Canadian Urological Association (CUA), and International Consultation on Incontinence are discussed. First, the methodologies and verbiage of the respective guidelines are examined. Then, the guidelines are reviewed as they relate to the major aspects of the diagnosis and management of neurogenic lower urinary tract dysfunction: clinical history; physical examination; risk assessment; laboratory and imaging investigations; urodynamics; non-invasive conservative management strategies; autonomic dysreflexia; medical management strategies for filling and emptying; assisted bladder drainage methods; minimally-invasive and surgical management for storage and emptying; surveillance and follow up; prevention, diagnosis, and treatment of urinary tract infection; sexual function and fertility. Finally, guidelines as they relate to pediatric neurogenic lower urinary tract dysfunction are discussed.KeywordsGuidelinesLevel of evidenceStrength of recommendationGRADE systemAmerican Urological AssociationCanadian Urological AssociationEuropean Association of UrologyNational Institute for Health and Care ExcellenceInternational Consultation on IncontinenceInternational Urodynamic Basic Spinal Cord Injury Data Set