Original Clinical Article

Lower urinary tract symptoms following neurological illness may be influenced by multiple factors: Observations from a neurorehabilitation service in a developing country†‡

  1. Jalesh N. Panicker1,2,*,
  2. Lakshmi Menon1,
  3. A. Anandkumar1,
  4. K.R. Sundaram3,
  5. Clare J. Fowler2

Article first published online: 27 MAY 2009

DOI: 10.1002/nau.20750

Issue

Neurourology and Urodynamics

Neurourology and Urodynamics

Volume 29, Issue 3, pages 378–381, March 2010

Additional Information

How to Cite

Panicker, J. N., Menon, L., Anandkumar, A., Sundaram, K.R. and Fowler, C. J. (2010), Lower urinary tract symptoms following neurological illness may be influenced by multiple factors: Observations from a neurorehabilitation service in a developing country. Neurourol. Urodyn., 29: 378–381. doi: 10.1002/nau.20750

Author Information

  1. 1

    Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India

  2. 2

    Department of Biostatistics, Amrita Institute of Medical Sciences, Kochi, India

  3. 3

    Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom

*Department of Uro-Neurology National Hospital for Neurology and Neurosurgery London WC1N 3BG, United Kingdom.

  1. †

    Conflicts of interest: none.

  2. ‡

    Dirk De Ridder Led the Review Process.

Publication History

  1. Issue published online: 22 MAR 2010
  2. Article first published online: 27 MAY 2009
  3. Manuscript Accepted: 3 APR 2009

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Keywords:

  • catheterization;
  • incontinence;
  • lower urinary tract dysfunction;
  • neurogenic;
  • unexpected symptoms

Abstract

Aims

To evaluate the pattern of lower urinary tract dysfunction (LUTD) in patients with neurological disease in the setting of a rehabilitation service in a developing country, and analyze causes for unexpected lower urinary tract symptoms (LUTS).

Methods

Patients with neurological disorders and having significant LUTS were prospectively evaluated. Level of neurological lesion was localized by neurological examination and investigations. LUTD was evaluated by symptom analysis, bladder diaries and ultrasonography. Storage symptoms were managed using antimuscarinic medications and voiding dysfunction, when significant, was managed by catheterization and patients were regularly followed up. Patients with symptoms that had not been expected based upon their level of neurological lesion were further evaluated.

Results

Fifty patients (mean age 43.5 ± 18.3 years) were included and according to neurological localization, were categorized into suprapontine (n = 9; 18%), infrapontine/suprasacral (n = 25; 50%) or infrasacral (n = 16; 32%) groups. Incontinence was more common in patients with suprapontine and infrapontine/suprasacral lesions (n = 20) (P < 0.03), hesitancy more common with infrapontine/suprasacral lesions (n = 20) (P = 0.004) and retention more with infrasacral lesions (n = 13) (P < 0.001). Patients belonging to suprapontine and infrapontine/suprasacral groups more likely showed improvement at follow up (P = 0.008). Fourteen patients (28%) had unexpected LUTS and this was due to urological causes (n = 6) or multiaxial neurological involvement (n = 8). Potentially treatable factors were managed, resulting in symptom relief.

Conclusion

LUTS in neurological disease may be at variance with the pattern expected based upon level of neurological lesion. Such patients may require further evaluation and consideration should be given to concomitant urological conditions and multiaxial neurological involvement. Neurourol. Urodynam. 29:378–381, 2010. © 2009 Wiley-Liss, Inc.

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