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REVIEW ARTICLE
Year : 2023  |  Volume : 34  |  Issue : 1  |  Page : 3-9

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


1 Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
2 Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
3 Division of Urology, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
4 Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital, Taichung; National Defense Medical Center, Taipei, Taiwan
5 Department of Urology, School of Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
6 Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
7 Department of Urology, Miaoli General Hospital, Ministry of Health and Welfare, Miaoli, Taiwan
8 Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
9 Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
10 Division of Urology, Department of Surgery, Yuanlin Christian Hospital, Changhua, Taiwan
11 Department of Urology, School of Medicine, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan
12 Division of Neural Regeneration and Repair, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
13 Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
14 Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei; Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan
15 Department of Urology, Far Eastern Memorial Hospital, New Taipei City, Taiwan

Correspondence Address:
Hann-Chorng Kuo
Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung-Yang Road, Hualien 97002
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/UROS.UROS_115_22

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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.


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