AUA/SUFU Neurogenic Lower Urinary Tract Dysfunction Guidelines ft. Dr. David Ginsburg

SUFU podcast

The American Urological Association (AUA), in partnership with the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) released the 2021 clinical guideline for the diagnosis, evaluation, treatment and follow-up of Neurogenic Lower Urinary Tract Dysfunction (NLUTD) in adults.

NLUTD is a term used to refer to the abnormal function of either the bladder, bladder neck and/or its sphincters related to a neurologic disorder. Prior terminology commonly used "neurogenic bladder" to describe this condition. With the understanding this is not an issue confined to the bladder, NLUTD is now the preferred way to describe the various voiding issues seen in patients with a neurologic disorder.
The focus of this guideline is on the evaluation, treatment and follow up of care for adults with NLUTD. A total of 60 recommendations, including those associated with initial evaluation, autonomic dysreflexia, urinary tract infections, non-surgical and surgical treatment options, as well as follow up and post treatment care are reflected within this new clinical guidance.

Highlights include:

• An algorithm that allows for risk stratification of patients with NLUTD (low-, moderate- or high-risk), helping guide appropriate follow-up and surveillance.
• Recommendations on which patients need to be monitored for autonomic dysreflexia (AD) during procedures and how to intervene if AD occurs.
• UTI recommendations focusing on issues such as not treating asymptomatic bacteruria, not obtaining screening urinalysis or culture in asymptomatic patients and the consideration of daily antibiotic prophylaxis for NLUTD patients who manage their bladder with clean intermittent catheterization and have recurrent UTI.
• Treatment options to improve bladder storage parameters such as oral therapies (antimuscarinics and/or beta-3 agonists) or, if oral therapies fail, onabotulinumtoxinA to improve bladder storage parameters, decrease episodes of incontinence, and improve quality of life measures.

David A. Ginsberg, MD is the Chair of the guideline development panel and Professor of Clinical Urology at the University of Southern California, Keck School of Medicine
Seth Cohen, MD is an Assistant Clinical Professor of Urology and specialist in Female Pelvic Medicine & Reconstructive Surgery at City of Hope follow him on Twitter at https://twitter.com/drscohen?lang=en