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Critical Reviews™ in Physical and Rehabilitation Medicine
SJR: 0.121 SNIP: 0.228 CiteScore™: 0.5

ISSN Imprimir: 0896-2960
ISSN On-line: 2162-6553

Critical Reviews™ in Physical and Rehabilitation Medicine

DOI: 10.1615/CritRevPhysRehabilMed.v21.i2.30
pages 167-195

The Management of Adult Neurogenic Lower Urinary Tract Dysfunction

Paolo Di Benedetto
Rehabilitation Medicine Department, Physical Medicine and Rehabilitation Institute, Udine, Italy
Tullio Giorgini
Rehabilitation Medicine Department, Physical Medicine and Rehabilitation Institute, Udine, Italy
Giulio Del Popolo
Neuro-Urology-Spinal Unit Department, Careggi University Hospital, Florence, Italy

RESUMO

Neurogenic lower urinary tract dysfunction (NLUTD) is commonly encountered in rehabilitation settings and is caused by a variety of pathologies. The management of spinal cord injury (SCI) has been the model of reference for the management of other pathologies associated with NLUTD. The introduction of clean, intermittent catheterization, the decline in renal-related mortality in SCI patients, and the algorithms proposed by the International Consultations on Incontinence underlined the need for an early, simple, but correct assessment and empiric treatment of patients whose predominant problems are urinary incontinence and retention. The aim of this review is to provide useful information for clinical practitioners, notably physiatrists, on NLUTD epidemiology, pathophysiology, classification, diagnosis, conservative management, and follow-up. The management of NLUTD has well-defined aims—protection of the upper urinary tract, improvement of urinary continence and voiding dysfunction, with beneficial effects on quality of life—and consists of noninvasive, conservative, and minimally invasive treatments. After an analytic description of the different approaches, the management of NLUTD in stroke, Parkinson’s disease, multiple sclerosis, and SCI patients is underlined. The importance of a dedicated team is emphasized, as well as the need for a urologist to provide for invasive treatments or major surgery if necessary.


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