Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Assessment of lower urinary tract dysfunction in patients with neurological conditions

  • When assessing lower urinary tract dysfunction in a person with neurological disease, 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 therapies.

  • If the dipstick test result and person's symptoms suggest an infection, arrange a urine bacterial culture and antibiotic sensitivity test before starting antibiotic treatment. Treatment need not be delayed but may be adapted when results are available.

  • Be aware that bacterial colonisation will be present in people using a catheter and so urine dipstick testing and bacterial culture may be unreliable for diagnosing active infection.

  • Refer people for urgent investigation if they have any of the following 'red flag' signs and symptoms:

    • haematuria

    • recurrent urinary tract infections (for example, 3 or more infections in the last 6 months)

    • loin pain

    • recurrent catheter blockages (for example, catheters blocking within 6 weeks of being changed)

    • hydronephrosis or kidney stones on imaging

    • biochemical evidence of renal deterioration.

Information and support

  • Offer people with neurogenic urinary tract dysfunction, their family members and carers specific information and training. Ensure that people who are starting to use, or are using, a bladder management system that involves the use of catheters, appliances or pads:

    • receive training, support and review from healthcare professionals who are trained to provide support in the relevant bladder management systems and are knowledgeable about the range of products available

    • have access to a range of products that meet their needs

    • have their products reviewed, at a maximum of 2 yearly intervals.

Treatment to improve bladder storage

  • Offer bladder wall injection with botulinum toxin type A to adults:

  • Ensure that patients who have been offered continuing treatment with repeated botulinum toxin type A injections have prompt access to repeat injections when symptoms return.

Treatment to prevent urinary tract infection

  • Do not routinely use antibiotic prophylaxis for urinary tract infections in people with neurogenic lower urinary tract dysfunction.

Monitoring and surveillance protocols

  • Offer lifelong ultrasound surveillance of the kidneys to people who are judged to be at high risk of renal complications (for example, consider surveillance ultrasound scanning at annual or 2 yearly intervals). Those at high risk include people with spinal cord injury or spina bifida and those with adverse features on urodynamic investigations such as impaired bladder compliance, detrusor-sphincter dyssynergia or vesico-ureteric reflux.

Access to and interaction with services

  • When managing the transition of a person from paediatric services to adult services for ongoing care of neurogenic lower urinary tract dysfunction:

    • formulate a clear structured care pathway at an early stage and involve the person and/or their parents and carers

    • involve the young person's parents and carers when preparing transfer documentation with the young person's consent

    • provide a full summary of the person's clinical history, investigation results and details of treatments for the person and receiving clinician

    • integrate information from the multidisciplinary health team into the transfer documentation

    • identify and plan the urological services that will need to be continued after the transition of care

    • formally transfer care to a named individual(s).

  • National Institute for Health and Care Excellence (NICE)