![]() ![]() Strategies that take into account the specific etiology of the NGB have had a marked impact on QoL and mortality in certain NGB populations, such as SCI and spina bifida, suggesting a need for more specific classification system of these disorders. This definition lacks sufficient detail to guide therapy, assess response to therapy, and predict future complications before they occur. The current standard for diagnosis and treatment of NGB, briefly described above and detailed below, is a clinical definition, and does not include imaging or biomarker data, nor does it stratify patients by cause or severity or include information on afferent or efferent signaling abnormalities. The recent American Urologic Association (AUA) Guideline on OAB does not advocate this level of workup for the routine patient ( 4). After the initial work up, periodic surveillance is recommended ( 3). Typically the diagnosis is made with an initial history and physical exam, but additional investigations such as a post void residual assessment, renal ultrasound, and urodynamic studies are also indicated. The location of the neurologic lesion will often determine the type of LUT dysfunction. This is important because unlike conditions with similar symptoms, such as overactive bladder (OAB), LUTS secondary to NGB can lead to progressive and sometimes life threatening complications such as urinary tract infections (UTIs), urosepsis, and renal failure ( 2). Though this clinical definition is commonly used, it lacks enough detail to inform treatment decisions or even assess progress after treatment has begun. Some causes include multiple sclerosis (MS), spinal cord injury (SCI), traumatic brain injury (TBI), cerebrovascular accident (CVA), spina bifida, cerebral palsy, transverse myelitis, and diabetes mellitus (DM) ( 2). This can decrease quality of life (QoL) and lead to significant long-term costs ( 1). It can remain asymptomatic until in some cases until lower urinary tract symptoms (LUTS) develop. ![]() ![]() Neurogenic bladder (NGB) is a term used by health care providers to describe dysfunction of the lower urinary tract (LUT) characterized by damage to the central nervous system (CNS), autonomic nervous system (ANS), or peripheral nervous system (PNS). Keywords: Urodynamics autonomic nervous system (ANS) brain-derived neurotrophic factor (BDNF) nerve growth factor (NGF) urinary bladder neurogenic We expect the SALE system to efficiently describe a patient suffering from NGB and simultaneously inform the most appropriate treatment, follow-up regimen, and long-term prognosis. In the future, as more definite prognostic information can be gleaned from biomarkers, we anticipate adding urinary nerve growth factor (NGF) and urinary brain-derived neurotrophic factor (BDNF) levels to the definition. In addition, the presence or absence of bowel dysfunction and autonomic dysreflexia will be reported. This is termed SALE (Stratify by Anatomic Location and Etiology). We propose a classification system based on seven categories, each having a neurologic defect in a distinct anatomic location. It may be time for a new classification scheme to better define the bladder defect and prognosis, as well as inform treatment. This definition does not give the clinician much information about the bladder disorder, nor how to treat it, or even what the natural history of the disorder is likely to be. The common theme is a bladder disorder concomitant with a neurologic disorder. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |