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CONDITION/DISORDER SYNONYMS

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  • Detrusor sphincter dyssynergia (DSD)

  • Neurogenic detrusor overactivity (NDO)

  • Neurogenic dysfunctional voiding

  • Neurogenic lower urinary tract dysfunction (NLUTD)

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ICD-9-CM CODES

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  • 344.61 Cauda equine syndrome with neurogenic bladder

  • 596.4 Atony of bladder

  • 596.5 Other functional disorder of the bladder

  • 596.54 Neurogenic bladder NOS

  • 596.55 Detrusor sphincter dyssynergia

  • 788.3 Urinary incontinence

  • 788.30 Urinary incontinence, unspecified

  • 788.31 Urge incontinence

  • 788.39 Other urinary incontinence

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ICD-10-CM CODES

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  • N31.2 Flaccid neuropathic bladder, not elsewhere classified

  • N31.8 Other neuromuscular dysfunction of bladder

  • N31.9 Neuromuscular dysfunction of bladder, unspecified

  • N36.44 Muscular disorders of urethra

  • N39.41 Urge incontinence

  • N39.498 Other specified urinary incontinence

  • R32 Unspecified urinary incontinence

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PREFERRED PRACTICE PATTERNS1

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  • 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—acquired in adolescence or adulthood

  • 5E Impaired Motor Function and Sensory Integrity Associated with Progressive Disorders of the Central Nervous System

  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury

  • 5G: Impaired Motor Function and Sensory Integrity Associated with Acute or Chronic Polyneuropathies

  • 5H: Impaired Motor Function, Peripheral Nerve Integrity, and Sensory Integrity Associated with Nonprogressive Disorders of the Spinal Cord

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PATIENT PRESENTATION

A 30-year-old woman with multiple sclerosis (MS) reports having a urinary tract infection (UTI). She also states new onset of bladders symptoms including hesitancy, interrupted urine flow, and failure to empty completely. Urodynamic testing by her urologist reveals simultaneous contraction of the external urinary sphincter (EUS) and the detrusor muscle. Postvoid residual volume is150 cc. She is scheduled for a 2 week trial of InterStim.

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KEY FEATURES

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Description
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  • Involuntary loss of urine control in the presence of a known neurologic condition

  • NLUTD may be due to dysfunction of the detrusor (bladder smooth muscle), dysfunction of the EUS, or a combinationof both.

  • Clinical manifestation encompasses a wide range of symptoms

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Essentials of Diagnosis
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  • Urodynamic testing is valuable in making diagnosis

  • NDO

    • High detrusor pressure during leakage episode during urodynamic testing is indicative of detrusor over activity

  • DSD

    • Simultaneous contraction of the EUS and detrusor during an attempt to void

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General Considerations
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  • Typical neurological patterns2

    • Higher lesions typically lead to a more reflexic LUT.

    • Lower lesions lead to a more areflexic LUT.

      • Lesions between T10 and L2 can be either reflexic or areflexic.

  • Severe neurological or non-neurological dysfunctional voiding puts ureteral and renal function at risk.

  • Other common urogynecologic conditions, such as pelvic organ prolapse, may also cause bladder symptoms.

  • Rule out lower UTIs.

    • Sudden onset of symptoms.

    • Urinary frequency.

    • Urinary urgency.

    • Lower back pain.

  • Rule out myogenic dysfunction of the detrusor.

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Demographics
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  • CVA: 28% to 79% after stroke3

  • Parkinson’s: Voiding dysfunction occurs in 35% to 70%of patients.4

  • Multiple system atrophy ...

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