Behavioural treatments
- clinician should consider a behavioural management programme (for example, timed voiding, bladder retraining or habit retraining) for people with neurogenic lower urinary tract dysfunction:
- only after assessment by a healthcare professional trained in the assessment of people with neurogenic lower urinary tract dysfunction and
- in conjunction with education about lower urinary tract function for the person and/or their family members and carers
- note that when choosing a behavioural management programme, take into account that prompted voiding and habit retraining are particularly suitable for people with cognitive impairment.
Antimuscarinics
- offer antimuscarinic drugs to people with:
- spinal cord disease (for example, spinal cord injury or multiple sclerosis) and
- symptoms of an overactive bladder such as increased frequency, urgency and incontinence
- consider antimuscarinic drug treatment in people with:
- conditions affecting the brain (for example, cerebral palsy, head injury or stroke) and
- symptoms of an overactive bladder
- consider antimuscarinic drug treatment in people with urodynamic investigations showing impaired bladder storage
- monitor residual urine volume in people who are not using intermittent or indwelling catheterisation after starting antimuscarinic treatment
- when prescribing antimuscarinics, take into account that:
- antimuscarinics known to cross the blood-brain barrier (for example, oxybutynin) have the potential to cause central nervous system-related side effects (such as confusion)
- antimuscarinic treatment can reduce bladder emptying, which may increase the risk of urinary tract infections
- antimuscarinic treatment may precipitate or exacerbate constipation
Botulinum toxin type A
- in adults
- offer bladder wall injection with botulinum toxin type A3 to adults:
- with spinal cord disease (for example, spinal cord injury or multiple sclerosis) and
- with symptoms of an overactive bladder and
- in whom antimuscarinic drugs have proved to be ineffective or poorly tolerated
- offer bladder wall injection with botulinum toxin type A3 to adults:
- with spinal cord disease and
- with urodynamic investigations showing impaired bladder storage and
- in whom antimuscarinic drugs have proved to be ineffective or poorly tolerated
- in children
- bladder wall injection with botulinum toxin type A3 should be considered for children and young people:
- with spinal cord disease and
- with symptoms of an overactive bladder and
- in whom antimuscarinic drugs have proved to be ineffective or poorly tolerated
- consider bladder wall injection with botulinum toxin type A3 for children and young people:
- with spinal cord disease and
- with urodynamic investigations showing impaired bladder storage and
- in whom antimuscarinic drugs have proved to be ineffective or poorly tolerated
Alpha blockers:
- **do not offer alpha-blockers to people as a treatment for bladder emptying problems caused by neurological disease
Prophylaxis versus UTIs
- do not routinely use antibiotic prophylaxis for urinary tract infections in people with neurogenic lower urinary tract dysfunction
If stress incontinence then consider pelvic floor training.
Long term urinary catheterisation or intermittent urinary catheterisation may be required in addition to other conservative treatment options.
Augmentation cystoplasty may be used indicated in some patients.
Other surgical interventions such as urethral tape and sling surgery or creation of an artificial urinary sphincter may be indicated.
Notes:
- botulinum toxin
- before offering bladder wall injection with botulinum toxin type A:
- explain to the person and/or their family members and carers that a catheterisation regimen is needed in most people with neurogenic lower urinary tract dysfunction after treatment, and
- ensure that they are able and willing to manage such a regimen should urinary retention develop after the treatment
- monitor residual urine volume in people who are not using a catheterisation regimen during treatment with botulinum toxin type A
- monitor the upper urinary tract in people who are judged to be at risk of renal complications (for example, those with high intravesical pressures on filling cystometry) during treatment with botulinum toxin type A
Reference: