Neurologic urinary incontinence

• Neurogenic lower urinary tract dysfunction (LUT)
• Neurogenic dysfunctional voiding
• Neurogenic detrusor overactivity (NDO)
• Detrusor sphincter dyssynergia (DSD)

• 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

• 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

• 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

Description

• 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

Essentials of Diagnosis

• 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

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 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

Demographics

• 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% ...