Assessment of lower urinary tract dysfunction in neurological disease

• assessment of lower urinary tract dysfunction in patients with neurological conditions
  • assessment applies to new patients, those with changing symptoms and those requiring periodic reassessment of their urinary tract management
    • interval between routine assessments will be dictated by the person's particular circumstances (for example, their age, diagnosis and type of management) but should not exceed 3 years
      
      
• When assessing lower urinary tract dysfunction in a person with neurological disease, take a clinical history, including information about:
  • urinary tract symptoms
  • neurological symptoms and diagnosis (if known)
  • clinical course of the neurological disease
  • bowel symptoms
  • sexual function
  • comorbidities
  • use of prescription and other medication and therapies
• the clinician should also assess the impact of the underlying neurological disease on factors that will affect how lower urinary tract dysfunction can be managed, such as:
  • mobility
  • hand function
  • cognitive function
  • social support
  • lifestyle
• the clinician should undertake a general physical examination that includes:
  • measuring blood pressure
  • an abdominal examination
  • an external genitalia examination
  • a vaginal or rectal examination if clinically indicated (for example, to look for evidence of pelvic floor prolapse, faecal loading or alterations in anal tone)
• carry out a focused neurological examination, which may need to include assessment of:
  • cognitive function
  • ambulation and mobility
  • hand function
  • lumbar and sacral spinal segment function

Assessment of urinary function

• undertake a urine dipstick test using an appropriately collected sample to test for the presence of blood, glucose, protein, leukocytes and nitrites. Appropriate urine samples include clean-catch midstream samples, samples taken from a freshly inserted intermittent sterile catheter and samples taken from a catheter port. Do not take samples from leg bags
  • if the dipstick test result and person's symptoms suggest an infection, arrange a urine bacterial culture and antibiotic sensitivity test before starting antibiotic treatment
  • treatment need not be delayed but may be adapted when results are available
  • be aware that bacterial colonisation will be present in people using a catheter and so urine dipstick testing and bacterial culture may be unreliable for diagnosing active infection
• ask people and/or their family members and carers to complete a 'fluid input/urine output chart' to record fluid intake, frequency of urination and volume of urine passed for a minimum of 3 days
• consider measuring the urinary flow rate in people who are able to void voluntarily
• measure the post-void residual urine volume by ultrasound, preferably using a portable scanner, and consider taking further measurements on different occasions to establish how bladder emptying varies at different times and in different circumstances
• consider making a referral for a renal ultrasound scan in people who are at high risk of renal complications such as those with spina bifida or spinal cord injury

Reference:

• 1) NICE (August 2012). Urinary incontinence in neurological disease - Management of lower urinary tract dysfunction in neurological disease