Neurogenic LUTD

Question 1

Initial workup

Answer 1

H&P
UA
PVR
Voiding diary, pad test
Uroflow
UDS if unknown risk (not low risk)

Question 2

Low risk category

Answer 2

Suprapontine lesion (CVA, parkinson’s, TBI, cerebral palsy)
Lesion distal to the spinal cord (e.g. disk disease, pelvic surgery, diabetes)
Spontaneously voids with low PVR
No hydro, no bladder stones, no rUTIs
Stable LUTS

Question 2

Moderate risk

Answer 2

-UDS showing retention, BOO, or DO with incomplete emptying
-Elevated PVR
-Normal upper tract
-Normal renal function

Question 2

Management of autonomic dysreflexia

Answer 2

Drain bladder, stop study, watch BP
Treat with nitropaste

Question 3

High risk (any of these)

Answer 3

-Poor compliance
-VUR
-Hydro
-Renal scarring
-Staghorn
-Abnormal renal function

Question 4

Infection prevention for patients with NLUTD

Answer 4

No abx prophy if indwelling catheter or CIC
Bladder instillation is an option if CIC
Cranberry has no data

Question 5

Medications/treatments for NLUTD

Answer 5

alpha blockers if voids
antimuscarinics or anticholingergics
botox
sphincterotomy
AUS
sling
Bladder neck closure and drainage
PTNS
SNS
Augment, CCB
Urinary diversion