Neurogenic Detrusor Overactivity with Urinary Urgency and Frequency When Neuromodulation Has Not Controlled Symptoms
Clinical Scenario
This protocol addresses patients with neurogenic detrusor overactivity who present with urinary urgency, urinary frequency, and urgency urinary incontinence — storage symptoms arising from neurologically driven, involuntary detrusor contractions.
Prior Treatment — Goals Not Achieved
Sacral neuromodulation (or posterior tibial nerve stimulation in patients who void spontaneously) was the preceding intervention. The targets — meaningful decreases in urinary urgency, incontinence episodes, and urinary frequency — were not sufficiently reached. Failure to meet those goals is the trigger for escalation to this protocol.
Next Step — Partial Overview
For patients refractory to, or intolerant of, less invasive therapies, a surgical approach to bladder augmentation is among the options at this stage. The full protocol specifies which patients qualify, how this intervention is selected, and what further considerations apply.
References
- Clinicians may offer sacral neuromodulation to select NLUTD patients with urgency, frequency, and/or urgency incontinence.
- Clinicians may offer augmentation cystoplasty to select NLUTD patients who are refractory to, or intolerant of, less invasive therapies for detrusor overactivity and/or poor bladder compliance.
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