Clinical guidelines of patient-centered bladder management of neurogenic lower urinary tract dysfunction due to chronic spinal cord injury-part 1: Pathophysiology, treatment strategy, and priority

This article presents the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) for patients with chronic spinal cord injury (SCI) in Taiwan. This review article focuses on the pathophysiology, treatment strategies, and priorities of bladder management in patients with chronic SCI. The main problems of SCI-NLUTD are storage failure, voiding failure, and combined retention and voiding failure. The priorities in the management of SCI-NLUTD are as follows in order of importance: (1) preserving renal function, (2) preventing urinary tract infection, (3) achieving efficient bladder emptying, (4) avoiding indwelling catheter use, (5) obtaining patient agreement with management, and (6) avoiding medication after proper management. Management of NLUTD in SCI patients should be based on urodynamic study findings rather than inferences from neurologic evaluations. Conservative treatment and bladder management by clean intermittent catheterization should be the first-line option. When surgical intervention is necessary, less invasive types of surgery and reversible procedures should be considered first and any unnecessary surgery in the lower urinary tract should be avoided.