Addressing Sphincter Dysfunction in the Female with Neurogenic Lower Urinary Tract Dysfunction
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RECONSTRUCTED BLADDER FUNCTION & DYSFUNCTION (M KAUFMAN, SECTION EDITOR)
Addressing Sphincter Dysfunction in the Female with Neurogenic Lower Urinary Tract Dysfunction Javier E. Santiago 1 & Anne P. Cameron 1 & Roberto A. Navarrete 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Neurogenic sphincter dysfunction in females will be discussed with reference to both foundational and contemporary research with an emphasis on tools for urologic management. The article will focus on both conservative and surgical options for patients broadly characterized with underactive or overactive sphincter dysfunction. Recent Findings There is limited recently published prospective data to guide management; however, there exist several insightful retrospective studies to guide practice. Summary The bulk of literature for the management of sphincter dysfunction for this complex patient population remains retrospective, and choice of intervention continues to rely upon individual patient characteristics and goals of care to maintain safety and quality of life. Keywords Neurogenic lower urinary tract dysfunction . Sphincter dysfunction . Neurogenic bladder . Urinary incontinence . Reconstructive urology
Introduction Normal internal and external urinary sphincter function is dependent upon a coordinated interplay of neuromuscular events to facilitate voiding in a volitional and safe manner that upholds the desired quality of life standards. This system controlling urinary sphincter function is compromised in many patients who sustain neurologic insult. There is a high prevalence of neurogenic lower urinary tract dysfunction (NLUTD), including sphincter dysfunction, in several neurologic conditions including multiple sclerosis and spina bifida, and following spinal cord injury. These patients pose unique
management considerations for which urologists should be armed with behavioral, pharmacologic, and surgical treatment options. The importance of concurrent management of neurogenic detrusor overactivity cannot be overstated. Herein, we review the pathophysiology, epidemiology, and management of urinary sphincter dysfunction in female patients with neurogenic bladder. One must also consider that patients with NLUTD remain susceptible to the same risk factors for urinary incontinence as other women including birth trauma and parity.
Relevant Neuromuscular Anatomy This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction * Javier E. Santiago [email protected] Anne P. Cameron [email protected] Roberto A. Navarrete [email protected] 1
Department of Urology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5330, USA
Under normal circumstances, urinary storage and voiding are under multiple levels of neurologic control. At the cerebral and diencephalic level, a coalition of structures including the right inferior frontal and dorsolateral prefrontal cortices, thalamus, insula, and anterior cingulate provides toni
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