J Kutzenberger1,2, A Angermund3, B Domurath4, S Möhr5, J Pretzer6, I Soljanik7, R Kirschner-Hermanns8. 1. Departement Neuro-Urologie, Kliniken Hartenstein - UKR, Bad Wildungen, Deutschland. jfkutzenberger@aol.com. 2. , Fontanestr. 16, 34596, Bad Zwesten, Deutschland. jfkutzenberger@aol.com. 3. Neuro-Urologie, Schön Klinik Vogtareuth, Vogtareuth, Deutschland. 4. Zentrum für Neuro-Urologie, Kliniken Beelitz, Beelitz-Heilstätten, Deutschland. 5. Neuro-Urologie, REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Basel, Schweiz. 6. Klinik für Urologie und Neuro-Urologie, Unfallkrankenhaus Berlin, Berlin, Deutschland. 7. Klinik für Paraplegiologie, Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Universität Heidelberg, Heidelberg, Deutschland. 8. Universitätsklinikum Bonn, Sektion Neuro-Urologie/, Klinik für Urologie und Kinderurologie und Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshöhe e. V., Bonn, Deutschland.
Abstract
BACKGROUND: In Germany about one million patients suffer from neurogenic lower urinary tract dysfunction (NLUTD). If left untreated, various forms of NLUTD can lead to secondary damage of the lower and upper urinary tract. Thus, the guideline was developed for the drug therapy of patients with NLUTD, who frequently require lifelong care and aftercare. METHODS: The guideline was developed in a consensus process with several meetings and online reviews, and final recommendations were decided on in online consensus meetings. Ballots were sent to elected officials of the contributing professional societies. Level of consensus was given for each coordinated recommendation ( https://www.awmf.org/leitlinien/detail/ll/043-053.html ). RESULTS/MOST IMPORTANT RECOMMENDATIONS: (Video)urodynamic classification of the NLUTD should be conducted before the use of antimuscarinic drugs (84.2%). Approved oral antimuscarinics should be used as first choice. Contraindications must be respected (100%). If oral treatment is ineffective or in the case of adverse drug reaction (ADRs) alternatively instillation of oxybutynin solution intravesically (83%) or onabotulinumneurotoxine (OBoNT) injection should be offered (89.5%). In case of failure or ADRs of antimuscarinics, β3 sympathomimetic mirabegron can be used to treat neurogenic detrusor overactivity (NDO) (off-label use) (100%). In case of paraplegia below C8 or multiple sclerosis with an expanded disability status scale (EDSS) of ≤ 6.5, OBoNT injection can be offered as an alternative (89.5%). Drug therapy for NDO should be started early in newborns/young children (84.2%). Conservative, nondrug therapy should be considered in frail elderly (94.7%). No parasympathomimetic therapy should be used to treat neurogenic detrusor underactivity (94.7%). CONCLUSION: Precise knowledge of the neurological underlying disease/sequence of trauma and the exact classification of the NLUTD are required for development of individualized therapy.
BACKGROUND: In Germany about one million patients suffer from neurogenic lower urinary tract dysfunction (NLUTD). If left untreated, various forms of NLUTD can lead to secondary damage of the lower and upper urinary tract. Thus, the guideline was developed for the drug therapy of patients with NLUTD, who frequently require lifelong care and aftercare. METHODS: The guideline was developed in a consensus process with several meetings and online reviews, and final recommendations were decided on in online consensus meetings. Ballots were sent to elected officials of the contributing professional societies. Level of consensus was given for each coordinated recommendation ( https://www.awmf.org/leitlinien/detail/ll/043-053.html ). RESULTS/MOST IMPORTANT RECOMMENDATIONS: (Video)urodynamic classification of the NLUTD should be conducted before the use of antimuscarinic drugs (84.2%). Approved oral antimuscarinics should be used as first choice. Contraindications must be respected (100%). If oral treatment is ineffective or in the case of adverse drug reaction (ADRs) alternatively instillation of oxybutynin solution intravesically (83%) or onabotulinumneurotoxine (OBoNT) injection should be offered (89.5%). In case of failure or ADRs of antimuscarinics, β3 sympathomimetic mirabegron can be used to treat neurogenic detrusor overactivity (NDO) (off-label use) (100%). In case of paraplegia below C8 or multiple sclerosis with an expanded disability status scale (EDSS) of ≤ 6.5, OBoNT injection can be offered as an alternative (89.5%). Drug therapy for NDO should be started early in newborns/young children (84.2%). Conservative, nondrug therapy should be considered in frail elderly (94.7%). No parasympathomimetic therapy should be used to treat neurogenic detrusor underactivity (94.7%). CONCLUSION: Precise knowledge of the neurological underlying disease/sequence of trauma and the exact classification of the NLUTD are required for development of individualized therapy.
Authors: K E Andersson; R Appell; L D Cardozo; C Chapple; H P Drutz; A E Finkbeiner; F Haab; R Vela Navarrete Journal: BJU Int Date: 1999-12 Impact factor: 5.588
Authors: Paul Abrams; Con Kelleher; David Staskin; Tomasz Rechberger; Richard Kay; Reynaldo Martina; Donald Newgreen; Asha Paireddy; Rob van Maanen; Arwin Ridder Journal: Eur Urol Date: 2014-02-19 Impact factor: 20.096
Authors: G Amarenco; M Sutory; R Zachoval; M Agarwal; G Del Popolo; R Tretter; G Compion; D De Ridder Journal: Neurourol Urodyn Date: 2015-12-29 Impact factor: 2.696
Authors: Ernesto Callegari; Bimal Malhotra; Peter J Bungay; Rob Webster; Katherine S Fenner; Sarah Kempshall; Jennifer L LaPerle; Martin C Michel; Gary G Kay Journal: Br J Clin Pharmacol Date: 2011-08 Impact factor: 4.335
Authors: Paul Abrams; Gerard Amarenco; August Bakke; Andrzej Buczyński; David Castro-Diaz; Simon Harrison; Guus Kramer; Robert Marsik; Andrzej Prajsner; Manfred Stöhrer; Philip Van Kerrebroeck; Jean Jacques Wyndaele Journal: J Urol Date: 2003-10 Impact factor: 7.450