Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation

At initial evaluation, clinicians should identify patients as either:
a. low-risk, or
b. unknown risk, who will require further evaluation to allow for complete risk stratification.
(Clinical Principle)


At initial evaluation, all patients with NLUTD should undergo a detailed history, physical exam, and urinalysis.
(Clinical Principle)


At initial evaluation, patients with NLUTD who spontaneously void should undergo post-void residual measurement.
(Clinical Principle)


At initial evaluation, optional studies in patients with NLUTD include a voiding/catheterization diary, pad test, and non-invasive uroflow.
(Expert Opinion)


At initial evaluation, in patients with low-risk NLUTD, the clinician should not routinely obtain upper tract imaging, renal function assessment, or multichannel urodynamics.
(Moderate Recommendation; Evidence Level: Grade C)


At initial evaluation, in patients with unknown-risk NLUTD, the clinician should obtain upper tract imaging, renal function assessment, and multichannel urodynamics.
(Moderate Recommendation; Evidence Level: Grade C)


In the patient with an acute neurological event resulting in NLUTD, the clinician should perform risk stratification once the neurological condition has stabilized.
(Clinical Principle)


Clinicians should not perform routine cystoscopy in the initial evaluation of the NLUTD patient.
(Clinical Principle)

During urodynamic testing and/or cystoscopic procedures, clinicians must hemodynamically monitor NLUTD patients at risk for autonomic dysreflexia.
(Clinical Principle)


For the NLUTD patient who develops autonomic dysreflexia during urodynamic testing and/or cystoscopic procedures, clinicians must terminate the study, immediately drain the bladder, and continue hemodynamic monitoring.
(Clinical Principle)


For the NLUTD patient with ongoing autonomic dysreflexia following bladder drainage, clinicians should initiate pharmacologic management and/or escalate care.
(Clinical Principle)