Conservative management of adult neurogenic lower urinary tract dysfunction

Neurogenic lower urinary tract dysfunction (NLTUD) is commonly encountered in neuro-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 approach to NLTUD due to many other diseases of the central and peripheral nervous system. The decline in renal-related mortality in SCI patients after the introduction of clean intermittent catheterization in association with pharmacological treatment (antimuscarinics in particular), and the algorithms proposed since 1998 by the International Consultations on Incontinence underline the need of early assessment and treatment of urinary incontinence and/or urinary retention in neuropathic patients. The aim of this brief review was to provide useful guidelines for physiatrists and neurologists in order to early and correctly manage all types of NLUTDS, well knowing that a correct management is useful not only for avoiding renal failure, but also for improving urinary continence, voiding dysfunction, and the quality of life of patients. The rehabilitation treatment consists of conservative, noninvasive or minimally invasive techniques, in the context of which intermittent catheterization and pharmacotherapy represent the more important modalities. After a brief description of specific interventions, the management of NLTUD in stroke, Parkinson's disease, multiple sclerosis and SCI patients is underlined, emphasizing the importance of a dedicated team in rehabilitation units.