Consultation in Neurourology: A Practical Evidence-Based Guide PDF
Preview Consultation in Neurourology: A Practical Evidence-Based Guide
Jacques 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 © Springer International Publishing AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland 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 xi 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
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