Clinical guidelines of patient-centered bladder management of neurogenic lower urinary tract dysfunction due to chronic spinal cord injury – Part 3: Surgical treatment in chronic spinal cord injured patients Lin YH, Fan YH, Wu CT, Shen YC, Hu JC, Huang SW, Chow PM, Chang PC, Liao CH, Chen YC, Lin VC, Hsu CC, Chang SJ, Wang CC, Lin WY, Lin CC, Jiang YH, Kuo HC,

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Clinical guidelines of patient-centered bladder management of neurogenic lower urinary tract dysfunction due to chronic spinal cord injury – Part 3: Surgical treatment in chronic spinal cord injured patients Yu-Hua Lin¹, Yu-Hua Fan², Chun-Te Wu³, Yuan-Chi Shen⁴, Ju-Chuan Hu⁵, Shi-Wei Huang⁶, Po-Ming Chow⁷, Po-Chih Chang⁸, Chun-Hou Liao⁹, Yu-Chen Chen¹⁰, Victor Chia-Hsiang Lin¹¹, Chih-Chen Hsu¹², Shang-Jen Chang⁷, Chung-Cheng Wang¹³, Wei-Yu Lin¹², Chih-Chieh Lin², Yuan-Hong Jiang¹⁴, Hann-Chorng Kuo¹⁴ ¹ Division of Urology, Department of Surgery, Cardinal Tien Hospital; Department of Chemistry, Fu Jen Catholic University, Taipei, Taiwan ² Department of Urology, Taipei Veterans General Hospital and College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan ³ Department of Surgery, Division of Urology, Chang Gung Memorial Hospital, Keelung; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan ⁴ School of Medicine, College of Medicine, Chang Gung University, Taoyuan; Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan ⁵ Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan ⁶ Department of Urology, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan ⁷ Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan ⁸ Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ⁹ Department of Urology, Cardinal Tien Hospital and College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan ¹⁰ Department of Urology, Kaohsiung Medical University Hospital and Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ¹¹ Department of Urology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan ¹² Department of Urology, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan ¹³ Department of Urology, En Chu Kong Hospital, Taipei; Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan ¹⁴ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, 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 Source of Support: None, Conflict of Interest: None DOI: 10.4103/UROS.UROS_118_22

This article reports the current evidence and expert opinions on patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among chronic spinal cord injured (SCI) patients in Taiwan. The main problems with SCI-NLUTD are failure to store, empty, or both. The management of SCI-NLUTD should be prioritized as follows: (a) preservation of renal function, (b) freedom from urinary tract infection, (c) efficient bladder emptying, (d) freedom from indwelling catheters, (e) patient agreement with management, and (f) avoidance of medication after proper management. The management of NLUTD in SCI patients must be based on urodynamic findings rather than neurologic evaluation inferences. It is important to identify high-risk patients to prevent renal functional deterioration in those with chronic SCI-NLUTD. Urodynamic studies should be performed on patients with SCI on a regular basis, and any urological complications should be adequately treated. When surgery is required, less invasive and reversible procedures should be considered first, and any unnecessary surgery in the lower urinary tract should be avoided. The most important aspect of treatment is to improve the quality of life in SCI patients with NLUTD. Annual active surveillance of bladder and renal function is required to avoid renal function deterioration and urological complications, particularly in high-risk SCI patients.

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    -  Fan YH
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