Table Of ContentJacques Corcos
Mikolaj Przydacz
Consultation in
Neurourology
A Practical
Evidence-Based Guide
123
Consultation in Neurourology
Jacques Corcos • Mikolaj Przydacz
Consultation in
Neurourology
A Practical Evidence-Based Guide
Jacques Corcos Mikolaj Przydacz
Department of Urology Department of Urology
Jewish General Hospital Jewish General Hospital
McGill University McGill University
Montreal, QC, Canada Montreal, QC, Canada
ISBN 978-3-319-63909-3 ISBN 978-3-319-63910-9 (eBook)
https://doi.org/10.1007/978-3-319-63910-9
Library of Congress Control Number: 2017947903
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Foreword I
Patients impacted by neurologic injury and disease have many bothersome
symptoms that can impact many facets of their life. However, it is well known
that lower urinary tract symptoms secondary to a neurologic issue often have
a substantial impact on the quality of life of these patients. The pathophysiol-
ogy, evaluation, and management of patients with neurogenic bladder are
well reviewed in many previously published textbooks, review articles, and
chapters. In fact, I had the good fortune of being a coeditor with Dr. Corcos
on the third edition of Textbook of the Neurogenic Bladder published in 2016.
So why another book on this subject?
There are many patients in the world with neurologic issues, and many of
them have bothersome symptoms related to neurogenic lower urinary tract
dysfunction (NLUTD). Unfortunately, there are few physicians who truly
focus on the care of NLUTD. Two physicians who truly do focus on the man-
agement of NLUTD, Dr. Jacques Corcos and Dr. Mikolaj Przydacz, have
taken a unique direction with this textbook. The focus is on the clinical man-
agement of patients with neurogenic bladder. The book separates NLUTD
into patients with and without spinal cord injury. Treatment options are
reviewed for the various types of clinical scenarios that are seen—urinary
incontinence due to detrusor overactivity, urinary incontinence due to poor
sphincteric function, and urinary retention. The various complications of
NLUTD are discussed (e.g., urinary tract infections, stones, autonomic dys-
reflexia, renal damage, etc.), followed by focused sections on patient educa-
tion and current guidelines for the management of NLUTD.
I would expect this textbook to be helpful to all healthcare providers who
care for patients with neurologic issues and NLUTD. For those healthcare
providers who have less experience with the field, the book will provide the
base of knowledge required to adequately manage these patients, and for
those healthcare providers who are already experienced in the field, I suspect
that there are pearls of wisdom that we can all apply to our clinical
practices.
USC Institute of Urology, David A. Ginsberg
Rancho Los Amigos National Rehabilitation Center
University of Southern California,
Los Angeles, CA, USA
v
Foreword II
Neurogenic lower urinary tract dysfunction is highly prevalent and affects the
life of millions of people worldwide. It has not only a major impact on the
quality of life but also imposes a substantial economic burden on every
healthcare system. Nevertheless, although neurourology is becoming a more
and more regarded subspecialty, bridging the fields of both neurology and
urology, it is still a “stepchild” with an urgent need for well-trained and
highly motivated researchers and clinicians to improve the care of patients
with neurourological problems.
The control of lower urinary tract function is a complex, multilevel, cen-
tral, and peripheral process with a neural network distributed across parasym-
pathetic, sympathetic, and somatic pathways. It is therefore not surprising
that many neurological disorders, such as multiple sclerosis, Parkinson’s dis-
ease, stroke, spinal cord injury, spina bifida, diabetic neuropathy, Alzheimer’s
disease, etc., frequently result in lower urinary tract dysfunction. The location
and extent of the lesion in the neurological axis determine the dysfunction
pattern, which is reflected in the patient’s symptoms. Indeed, the variability
of neurogenic lower urinary tract dysfunction is huge and may range from a
completely asymptomatic situation to end-stage renal failure requiring
hemodialysis.
The prevalence and incidence of several neurological disorders are already
high, and neurodegenerative disorders such as Alzheimer’s disease will fur-
ther increase in the course of a continuously aging population so that more
and more neurological patients will require professional neurourological
management. This, however, can be provided only by adequately trained cli-
nicians and enthusiastic researchers, because many questions regarding neu-
ral control of lower urinary tract function and its alterations through the
course of a neurological disorder remain unclear.
The major goal in neurourology is to protect the upper urinary tract and to
achieve urinary continence and a good quality of life. Timely diagnosis and
treatment are essential, and most neurourological patients need lifelong care.
Clinical assessment should be comprehensive and usually includes urody-
namics. Conservative and noninvasive therapies must be tested before surgi-
cal procedures are considered. Finally, an individualized, patient-tailored
approach is required for the management of neurogenic lower urinary tract
dysfunction.
There are several excellent books on neurourology available, but the work
by Drs. Corcos and Przydacz is different: It is the joint conclusion by one of
vii
viii Foreword II
the most experienced specialists in the field and a young enthusiastic talent—
two generations provide us with an extremely helpful evidence-based guide
for daily practice, a must for all interested in neurourology! Enjoy the read-
ing—you will be thrilled!
Neuro-Urology, Spinal Cord Injury Center Thomas M. Kessler
Balgrist University Hospital, University of Zürich,
Zürich, Switzerland
Preface
Several good quality textbooks, books, and book chapters exist already on top
of well-developed international and national guidelines to help the practice
and understanding of the complex and fascinating field of neurourology.
However, my personal long experience in this field compelled me to consider
a new book with a different approach, one focused on our daily practice. This
book is aimed to bring the reader into the heart of the action of any health
professional consulted for a patient with a neurogenic bladder. This role-play
idea explains the original plan of this project.
For this book, which will hopefully guide every student and physician
dealing with these conditions, I had the opportunity to involve Dr. Mikolaj
Przydacz, a young and bright urologist at the dawn of his practice, who
quickly understood the global idea of this “real-life” book and became fully
involved in its writing. Thanks to him for his full commitment to the project,
for his patience, and for his excellent work.
Montreal, QC, Canada Jacques Corcos
Mikolaj Przydacz
ix
Contents
Part I Introduction
1 Book Presentation with Overview of Bladder Physiology ......... 3
Book Presentation ........................................................................... 3
Organization of Summaries and Recommendations ....................... 3
Overview of the Physiology of Lower Urinary Tract ..................... 4
References ....................................................................................... 6
2 Neurogenic Bladder Pathophysiology ......................................... 7
Introduction ..................................................................................... 7
Neurogenic Detrusor Overactivity .................................................. 7
Neurogenic Detrusor Underactivity ................................................ 9
Detrusor-Sphincter Dyssynergia ..................................................... 12
Neurogenic Sphincter Deficiency ................................................... 12
Conclusion ...................................................................................... 12
References ....................................................................................... 13
3 Pathologies Responsible for the Development
of the Neurogenic Bladder ............................................................ 17
Introduction ..................................................................................... 17
Traumatic Entities and Their Neurourological Consequences ....... 18
Head Injury ................................................................................. 18
Spinal Cord Injury ....................................................................... 19
Non-traumatic Entities and Their Neurourological Consequences 20
Suprapontine Lesion (Brain) ....................................................... 20
Infrapontine-Suprasacral Lesion (Spinal Cord) .......................... 26
Sacral-Infrasacral Lesion (Spinal Cord and Peripheral Nervous
System) ....................................................................................... 28
Conclusion ...................................................................................... 31
References ....................................................................................... 32
Part II First Consultation of Patients with Spinal Cord Injury
4 Medical History and Physical Examination ............................... 39
Introduction ..................................................................................... 39
Medical History .............................................................................. 39
Physical Examination ...................................................................... 42
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xii Contents
Conclusion ...................................................................................... 46
References ....................................................................................... 47
5 Testing ............................................................................................ 49
Introduction ..................................................................................... 49
Recommended Tests ....................................................................... 49
Urinalysis/Urine Culture ............................................................. 49
Blood Chemistry ......................................................................... 50
Voiding Diary .............................................................................. 50
Post-void Residual ...................................................................... 52
Urinary Tract Ultrasound ............................................................ 52
Elective Tests .................................................................................. 55
Urethrocystoscopy ...................................................................... 55
Computed Tomography, Magnetic Resonance
Imaging, Others ........................................................................... 56
Uroflowmetry .............................................................................. 56
Urodynamic Testing .................................................................... 57
Video-Urodynamics .................................................................... 60
Specialist Uro-neurophysiological Tests ..................................... 62
Conclusion ...................................................................................... 62
References ....................................................................................... 63
6 Bladder Management and Follow-Up Plan ................................ 67
Introduction ..................................................................................... 67
Bladder Management ...................................................................... 67
Follow-up Plan ................................................................................ 67
Conclusion ...................................................................................... 72
References ....................................................................................... 73
Part III Consultations for Main Complaints in Neurogenic Bladder
7 Incontinence Due to Neurogenic Detrusor Overactivity ........... 77
Introduction ..................................................................................... 77
Epidemiology .................................................................................. 77
Diagnosis ......................................................................................... 79
History and Physical Examination .............................................. 79
Bladder Diary and Questionnaires .............................................. 80
Urinalysis and Urine Culture ...................................................... 81
Pad-Weighing Test ...................................................................... 82
Renal Evaluation ......................................................................... 82
Other Investigations .................................................................... 83
Urodynamics ............................................................................... 83
Treatment ........................................................................................ 89
Conservative Treatment .............................................................. 89
Pharmacological Treatment ........................................................ 90
Botulinum Toxin A Injections..................................................... 93
Neurostimulation/Neuromodulation ........................................... 96
Surgery ........................................................................................ 101
Conclusion ...................................................................................... 103
References ....................................................................................... 105
