This protocol addresses neurogenic lower urinary tract dysfunction (NLUTD) in patients presenting with incomplete bladder emptying and the following specific features:
Facilitating adequate bladder emptying is a central management priority in NLUTD. Intermittent catheterization is the recommended approach to manage incomplete emptying over indwelling catheter use in this population.
For appropriately selected male patients, a surgical procedure targeting the external urethral sphincter may be offered to facilitate bladder emptying. Counselling regarding the risk of failure or the potential need for further intervention is an integral part of this management pathway. The complete selection criteria, procedural approach, and post-procedure drainage plan are detailed in the full protocol.
Clinicians should recommend intermittent catheterization rather than indwelling catheters to facilitate bladder emptying in patients with NLUTD.
Clinicians may recommend alpha-blockers to improve voiding parameters in NLUTD patients who spontaneously void.
Clinicians may offer sphincterotomy to facilitate emptying in appropriately selected male patients with NLUT but must counsel them of the high-risk of failure or potential need for additional treatment or surgery.
A review of studies of patients who underwent a sphincterotomy reported that while MCC generally did not change, patients showed improvements in PVR, MDP, end filling detrusor pressure, and DLPP.
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