CUA NLUTD 2019 GL Flashcards
(55 cards)
List a few complications of neurogenic bladder?
urinary incontinence, UTI, urolithiasis, sepsis, ureteric obstruction, VUR, Renal failure
What is the general categorizaiton of NLUTD for suprapontine, infrapotine-suprasacral, and sacral/infra-sacral lesions?
Should voiding diaries be encouraged for all patients with NLUTD?
yes. GL says so
what do you do if your NLUTD has PVR>300
follow them and make sure it is stable. Obv need to also make sure they have a low pressure reservoir and good compliance etc
Who should have UDS, renal-bladder imaging(US) and renal function checked?
Patients with
1- spina bifida
2-advanced stage MS
3-SCI
Are VUDS preferred for patients for NLUTD?
yes, patients with NLUTD should have UDS and preferrably VUDS
What is a cut off for a safe DLPP?
40 but this is based on historical values and pediatric literature. and the lower it is the better, the issue is that the lower the DLPP the more likely patient is gonna have incontiennce
What kind of findings one may see on KUB US in NLUTD?
HN, bladder wall thickening, elevated PVR, bladder or renal stones, bladder diverticula, renal atrophy
What is the best way to measure renal function in NLUTD?
Is renal dysfunction common in MS due to bladder dysfunction?
serial Cr, nuclear medicine scan, 24 hour urine collection,
NO, it can occur but uncommon
What UDS findings in NLUTD are concerning for urological morbidity?
Compliance <20, DLPP>40, DSD, NDO, VUR
IS there a role for use of screening cystoscopy programs for NLUTD? are they at higher risk of bladder cancer? how does cytology fare?
No, dont do cysto without cause
They are at higher risk of bladder ca and more likely to have advanced disease
A recent metanalysis showed cytology outperformed cysto in select populations(word for word from GL..)
What are the high risk faeatures and what are the 5 domains that you gotta pay attention to when assessing NLUTD?
Know this table
GL Statement: All patients with neurogenic bladder should have …. and ….as part of their initital evaluation
UA and PVR
GL statement: How long after SCI should a patients have their baseline urological assessment?
Within 6 months
which NLUTD patients would be moderate risk? who would be high risk?
Moderate risk: anyone with SCI, SB or advanced MS
High risk: any of the above groups with high risk features covered earlier. ( there are 5 domains and each have high risk features in)
Overview of management of NLUTD
What are two theories of upper urinary tract deterioation from neurogenic bladder?
1- high pressure obstructs the orficies and obstruction fucks shit up
2- high pressure overwhelms the UVJ mechanisms and that causes reflux and fucks up the upper tract
What would leakage between CIC episodes be suggestive of?
high storage pressures probably
Who with NLUTD would need an indwelling catheter?
CIC is preferred but
non compliant patietns, those with poor dexterity, or those with mental deficiencies
what are long-term complications of urethral cathetrizaiton in men and women?
men: false passage, strictures, diverticuli, iatrogenic hypospadias
females: dilatation, erosion, potentially destruction
If someone has an indwelling catheter at risk of urethral damage? what should be done for them?
Conversion to a SP catheter before irriversible damage is done to urethra, should be done for patients who are at risk of urethral complications
If a Neurogenic patient has recurrent falls. what should a urologist do?
NDO with urge incontinece has been associated with falls. managed it
What is the most common cause of UTI in NLUTD?
Enterobacteriae family
especially: E.Coli
