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Condition/Disorder Synonyms

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  • Neurogenic lower urinary tract dysfunction (LUT)

  • Neurogenic dysfunctional voiding

  • Neurogenic detrusor overactivity (NDO)

  • Detrusor sphincter dyssynergia (DSD)

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ICD-9-CM Codes

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  • 344.61 Cauda equina syndrome with neurogenic bladder

  • 596.4 Atony of bladder

  • 596.5 Other functional disorders of 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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Key Features

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Description

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

  • Neurologic lower urinary tract (LUT) dysfunction may be due to dysfunction of the detrusor (smooth bladder muscle), dysfunction of the external urinary sphincter (EUS), or a combination of 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

  • Neurogenic detrusor overactivity

    • High detrusor pressure in leakage episode during urodynamic testing is indicative of detrusor overactivity

  • Detrusor sphincter dyssynergia (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 prolpase, may also cause bladder symptoms

  • Rule out lower urinary tract infections

    • 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 patients4

  • Multiple system atrophy (MSA): 73% complain of UI

  • Multiple sclerosis (MS): 95% of patients with disease over 10 years report urinary complaints5

  • Prevalence of neurogenic overactive bladder disorders in a U.S. claims database6 n= 46, 271 patients

    • 26.3% had neurogenic bladder not otherwise specified

    • 17.2% had MS diagnosis

    • 14.9% Parkinson's disease

    • 8.9% cauda equina syndrome

    • 7.8% ...

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