Abstract
Lower urinary tract dysfunction is a common sequel of neurological disease resulting
in symptoms that significantly impacts quality of life. The site of the neurological
lesion and its nature influence the pattern of dysfunction. The risk for developing
upper urinary tract damage and renal failure is considerably lower in patients with
slowly progressive nontraumatic neurological disorders, compared with those with spinal
cord injury or spina bifida. This acknowledged difference in morbidity is considered
when developing appropriate management algorithms. The preliminary evaluation consists
of history taking, and a bladder diary and may be supplemented by tests such as uroflowmetry,
post-void residual measurement, renal ultrasound, (video-)urodynamics, neurophysiology,
and urethrocystoscopy, depending on the clinical indications. Incomplete bladder emptying
is most often managed by intermittent catheterization, and storage dysfunction is
managed by antimuscarinic medications. Intra-detrusor injections of onabotulinumtoxinA
have revolutionized the management of neurogenic detrusor overactivity. Neuromodulation
offers promise for managing both storage and voiding dysfunction. In select patients,
reconstructive urological surgery may become necessary. An individualized, patient-tailored
approach is required for the management of lower urinary tract dysfunction in this
special population.
Keywords neurological disease - incontinence - botulinum toxin - tibial nerve stimulation
