This protocol addresses neurogenic lower urinary tract dysfunction (NLUTD) with neurogenic detrusor overactivity (NDO), urinary urgency, urinary frequency, and urgency urinary incontinence — in patients who have not adequately responded to first-line treatment.
The initial management of neurogenic detrusor overactivity and storage symptoms — which may include pelvic floor muscle training (particularly in patients with multiple sclerosis or cerebrovascular accident) and/or oral pharmacotherapy with antimuscarinics, beta-3 adrenergic receptor agonists, or a combination of both — did not adequately reach the following targets:
When oral pharmacotherapy and behavioural measures fall short, the next step involves a procedural intervention delivered directly to the detrusor. The full protocol specifies patient selection, the intervention, and relevant dosing considerations.
Clinicians may offer sacral neuromodulation to select NLUTD patients with urgency, frequency, and/or urgency incontinence.
In NLUTD patients with spinal cord injury or multiple sclerosis refractory to oral medications, clinicians should recommend onabotulinumtoxinA to improve bladder storage parameters, decrease episodes of incontinence, and improve quality of life measures.
In NLUTD patients, other than those with spinal cord injury and multiple sclerosis, who are refractory to oral medications, clinicians may offer onabotulinumtoxinA to improve bladder storage parameters, decrease episodes of incontinence, and improve quality of life measures.
There are no differences in efficacy between the 200 U and 300 U dose.
In patients with SCI or MS, a single set of intradetrusor injections of onabotulinumtoxinA reduces UI episodes, increases MCC, and decreases MDP compared to placebo groups.
View source ↗