Neurophysiology of Lower Urinary Tract: Clinical Relevance to Treatment of Females with Neurogenic Lower Urinary Tract Dysfunction (NLUTD)_ONDEMAND-RECORDING_Neurophysiology of Lower Urinary Tract: Clinical Relevance to Treatment of Females with Neurogenic Lower Urinary Tract Dysfunction (NLUTD)

RECORDING_Neurophysiology of Lower Urinary Tract: Clinical Relevance to Treatment of Females with Neurogenic Lower Urinary Tract Dysfunction (NLUTD)

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Video Summary

In this AUGS Urogynecology webinar, Dr. Toby Chai discusses the neurophysiology of the lower urinary tract focusing on females with neurogenic lower urinary tract dysfunction (NLUTD). Dr. Chai reviews the anatomy and neural control, highlighting the bladder's autonomic smooth muscle and the somatically controlled pelvic floor and external urethral sphincter. He emphasizes that neurologic lesions often cannot be reversed, so treatment typically involves managing symptoms, preventing complications like high bladder pressures, and improving quality of life. The talk covers guideline-based risk stratification and the importance of surveillance for renal function and urinary complications.<br /><br />Dr. Chai presents complex clinical cases illustrating treatment approaches, including bladder augmentation with ileocystoplasty and urinary diversion via catheterizable stomas for patients with poor voiding. He discusses challenges unique to females, such as difficulty with self-catheterization and urethral damage from chronic indwelling catheters. Surgical options are tailored to patients' abilities and goals, emphasizing shared decision-making. The management of elevated post-void residuals and recurrent UTIs, use of autologous versus mesh slings, and limited role of hydrodistension are addressed. He notes that sacral neuromodulation may benefit MS patients with overactive bladder. Overall, treatment aims to optimize urinary storage and emptying, preserve renal function, reduce infections, and improve life quality, acknowledging the complexity and individualized nature of NLUTD care.

Keywords

neurogenic lower urinary tract dysfunction

female urinary tract

neurophysiology

bladder augmentation

ileocystoplasty

urinary diversion

self-catheterization challenges

sacral neuromodulation

urinary tract infections