Neuro-Urology: Call for Universal, Resource-Independent Guidance

Abstract

Neurogenic lower urinary tract dysfunction (NLUTD), the abnormal function of the lower urinary tract in the context of neurological pathology, has been the subject of multiple efforts worldwide for the development of clinical practice guidelines. These guidelines are based on the same body of evidence, and are therefore subject to the same gaps. For example, sexual and bowel dysfunction in the context of NLUTD, optimal renal function assessment in those who are non-ambulatory or with low muscle mass, optimal upper tract surveillance timing, and modification of diagnostic and treatment modalities for low-resource nations and communities are inadequately addressed. In addition, many aspects of the conclusions and final recommendations of the guidelines are similar. This duplicative work represents a large expenditure of time and effort, which we believe could be focused instead on evidence gaps. Here, we call for a global unified approach to create a single, resource-independent, comprehensive guidance on NLUTD, neurogenic sexual, and neurogenic bowel dysfunction. Targeted research addressing the evidence gaps should be called for and pursued. This will allow for focus to shift to filling the gaps in the evidence for future guidelines.

Keywords: chronic kidney disease; clinical practice guidelines; cystatin C; detrusor overactivity; neurogenic bladder; neurogenic bowel; neurogenic lower urinary tract dysfunction; sexual dysfunction; urinary tract infection; voiding dysfunction.

Figure 1

Neuro-urology is a subspeciality bridging the fields of neurology and urology, symbolized by this illustration of the kidneys as brains. Cover picture from The Lancet Neurology, Volume 14, Issue 7, July 2015 (reproduced with permission).