Lower Urinary Tract Dysfunction in Neurological Illness may be Multifactorial: Observations from a Neurorehabilitation Service in a Developing Country

ABSTRACT

Introduction: Lower urinary tract dysfunction (LUTD) following neurological illness depends upon the level of lesion in the nervous system, causing a characteristic pattern of lower urinary tract symptoms (LUTS). However, a subset of patients may have symptoms that are at variance from the expected pattern.

Objectives: This study evaluates the pattern of LUTS in patients with neurological disease and analyzes the causes responsible for unexpected symptoms.

Methods: Patients with neurological disorders admitted for rehabilitation over one year and having significant LUTD were evaluated. The level of neurological lesion was localized by clinical examination. LUTS was evaluated from patient symptoms, a 3-day voiding diary, and transabdominal ultrasonography. Patients with symptoms that had not been expected based upon the neurological localization were further investigated. Voiding dysfunction was managed with clean intermittent self-catheterization and urgency/frequency with antimuscarinic medications.

Results: Fifty patients were evaluated; categorized into having suprapontine (n = 9), suprasacral (n = 25), or infrasacral (n = 16) lesions according to the level of neurological localization; and their LUTS were analyzed. Incontinence was more common in patients with suprapontine and suprasacral lesions than infrasacral lesions (P < 0.03), hesitancy more common in patients with suprasacral lesions (P = 0.004), and retention more in patients with infrasacral lesions (P < 0.001). Patients with suprapontine and suprasacral lesions had significantly improved LUTS compared to those with infrasacral lesions at follow-up (P = 0.008). Patients with unexpected LUTS were further investigated and additional factors were found in 14 patients. These included benign prostate enlargement (3), starting oxybutynin (1), calculus (1), and urinary tract infection (1). In 8, cause could not be determined (8). Potentially treatable factors were managed, resulting in symptom relief.

Conclusion: A simplified approach to management of LUTD is usually sufficient for the diagnosis, management, and follow-up of patients with neurogenic LUTD. Additional factors may contribute to LUTS and should be evaluated in patients with unexpected symptoms.

KEYWORDS: Neurogenic, lower urinary tract dysfunction, incontinence, catheterization

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