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Special Considerations in the Neurogenic Patient

  • Teresa L. DanforthEmail author
  • David Ginsberg
Chapter

Abstract

The primary goal in treatment of neurogenic bladder (NGB) is preservation of renal function, which is maintained with low storage pressures. The mainstay of evaluation of patients with NGB is urodynamics (UDS). UDS is essential in managing patients with NGB as most patients will require treatment modification based on their studies. More importantly, Nossier et al. demonstrated that up to 68 % of asymptomatic patients might be at risk for upper tract disease that would be otherwise undetected without UDS. Specific considerations during the study include patient positioning and autonomic dysreflexia (AD). Patients must be monitored closely during UDS for symptoms of AD as well as continuous blood pressure (BP) monitoring, as a portion of patients will be asymptomatic. If an episode of AD occurs, immediate bladder emptying followed by possible oral or topical medication can be used to lower BP. The use of fluoroscopy in patients with NGB is widespread as it allows one to evaluate the upper tracts for vesicoureteral reflux (VUR) and the outlet for detrusor-sphincter dyssynergia.

Keywords

Spinal Cord Injury Bladder Neck Detrusor Overactivity Neurogenic Bladder Spinal Cord Injury Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

NGB

Neurogenic bladder

UDS

Urodynamics

AD

Autonomic dysreflexia

BP

Blood pressure

VUR

Vesicoureteral reflux

SCI

Spinal cord injury

UTI

Urinary tract infection

FUDS

Fluorourodynamics

CFU

Colony forming units

BPE

Benign prostatic hypertrophy

DESD

Detrusor external sphincter dyssynergia

EMG

Electromyelography

NDO

Neurogenic detrusor overactivity

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of UrologySUNY Buffalo School of Medicine and Biomedical Sciences, Buffalo General HospitalBuffaloUSA
  2. 2.Department of UrologyKeck School of Medicine of USC, University of Southern CaliforniaLos AngelesUSA

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