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Consensus document on the multidisciplinary management of neurogenic lower urinary tract dysfunction in patients with multiple sclerosis
Author(s) -
MedinaPolo José,
Adot José María,
Allué Marta,
Arlandis Salvador,
Blasco Pedro,
Casanova Bonaventura,
MatíasGuiu Jorge,
Madurga Blanca,
MezaMurillo EdwinRoger,
MüllerArteaga Carlos,
RodríguezAcevedo Breogán,
Vara Jesús,
Zubiaur María Carmen,
LópezFando Luis
Publication year - 2020
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.24276
Subject(s) - medicine , urinary system , urinary incontinence , quality of life (healthcare) , referral , multidisciplinary approach , rehabilitation , dyssynergia , physical therapy , urology , nursing , social science , sociology
Aim Neurogenic lower urinary tract dysfunction (NLUTD) is very common in multiple sclerosis (MS) patients. Early diagnosis and treatment are crucial to avoid irreversible damage and improve quality of life. Our aim was to develop recommendations to improve NLUTD identification in MS patients, along with their referral and management. Methods A multidisciplinary group of 14 experts in the management of patients with MS and NLUTD (nine urologists, three neurologists, and two rehabilitators) was selected. A comprehensive review of the literature was undertaken and a set of recommendations was generated and submitted to a Delphi panel of 114 experts. Recommendations were presented according to the grade of agreement (GA). Results Early diagnosis in asymptomatic patients with risk factors for complications is recommended (GA 94%). Postvoid residual volume should be measured if changes in urinary symptoms (GA 87%), preferably ultrasound‐guided (GA 86%). Early referral to urologist is recommended if urinary incontinence (GA 91%), significant post‐void residual volume (94%), quality of life impairment (GA 98%) and recurrent urinary infections (GA 97%). The initial evaluation should include physical examination (GA 99%) and urodynamics including cystometry (GA 89%), pressure‐flow study (90%) and electromyography (GA 70%). The panel recommends multidisciplinary collaboration (GA 100%) with a rehabilitation specialist and trained nurses in the management of NLUTD (GA 99%). Conclusions Multidisciplinary management for patients with NLUTD due to MS is advised, including urologists, neurologists, rehabilitation, and nurses. Panel recommends early diagnosis with post‐void residual volume in symptomatic patients before referring to urologist and urodynamics when referred.