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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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  • 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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  • 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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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% paralytic syndrome (quaudriplegia, monoplegia lower extremity)
    • 10.6% stroke
    • 4.3% spinal cord injury
    • 3% spinabifida
    • 2.1% other paralytic syndrome
    • 2% cerebral palsy diagnosis
    • 1.8% hemiplegia and hemiparesis diagnosis
    • 1% spinal cord neoplasm
    • 0.3% ...

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