Management of lower urinary tract dysfunction in neurological disease: summary of NICE guidanceBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5074 (Published 08 August 2012) Cite this as: BMJ 2012;345:e5074
- Sharon Swain, senior research fellow1,
- Ralph Hughes, health economist1,
- Mark Perry, research fellow1,
- Simon Harrison, consultant urological surgeon2
- on behalf of the Guideline Development Group
- 1National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE, UK
- 2Mid-Yorkshire Hospitals NHS Trust, Department of Urology, Pinderfields Hospital, Wakefield WF1 4DG, UK
- Correspondence to: S Swain
A wide range of neurological conditions can affect the function of the lower urinary tract, potentially causing distressing symptoms and even renal damage. It is important to ask patients with neurological disease about urinary symptoms, as identifying these should lead to appropriate assessment and treatment, improvement in quality of life, and a reduction in long term morbidity. Clinicians can easily overlook urinary tract problems as they focus on other important clinical matters, but a better understanding of how to deal with lower urinary tract problems may increase the confidence of healthcare professionals in this area. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of lower urinary tract dysfunction in neurological disease.1
NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.
Patients needing assessment include those with newly diagnosed neurological disease; those with known neurological disease and new or changing symptoms suggesting urinary tract dysfunction; and those requiring periodic reassessment of their urinary tract management. The interval between routine assessments will depend on the person (for example, their age or diagnosis) but should not exceed three years.
Take a clinical history, including information about urinary tract symptoms; neurological symptoms and diagnosis (if known); clinical course of the neurological disease; bowel symptoms; sexual function; comorbidities; use of prescription and other medication and treatments.
Assess the impact of the underlying neurological disease on factors that will affect how lower urinary tract dysfunction can be managed, such as mobility, hand function, cognitive function, social support, and lifestyle.
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