272: NEUROLOGIC URINARY INCONTINENCE

CONDITION/DISORDER SYNONYMS

• Detrusor sphincter dyssynergia (DSD)

• Neurogenic detrusor overactivity (NDO)

• Neurogenic dysfunctional voiding

• Neurogenic lower urinary tract dysfunction (NLUTD)

ICD-9-CM CODES

• 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

ICD-10-CM CODES

• 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

PREFERRED PRACTICE PATTERNS¹

• 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

KEY FEATURES

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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.

Demographics

• CVA: 28% to 79% after stroke³

• Parkinson’s: Voiding dysfunction occurs ...