assessment of lower urinary tract dysfunction in patients with neurological conditions
assessment applies to new patients, those with changing symptoms and those requiring periodic reassessment of their urinary tract management
interval between routine assessments will be dictated by the person's particular circumstances (for example, their age, diagnosis and type of management) but should not exceed 3 years
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
the clinician should also assess the impact of the underlying neurological disease on factors that will affect how lower urinary tract dysfunction can be managed, such as:
mobility
hand function
cognitive function
social support
lifestyle
the clinician should undertake a general physical examination that includes:
measuring blood pressure
an abdominal examination
an external genitalia examination
a vaginal or rectal examination if clinically indicated (for example, to look for evidence of pelvic floor prolapse, faecal loading or alterations in anal tone)
carry out a focused neurological examination, which may need to include assessment of:
cognitive function
ambulation and mobility
hand function
lumbar and sacral spinal segment function
Assessment of urinary function
undertake a urine dipstick test using an appropriately collected sample to test for the presence of blood, glucose, protein, leukocytes and nitrites. Appropriate urine samples include clean-catch midstream samples, samples taken from a freshly inserted intermittent sterile catheter and samples taken from a catheter port. Do not take samples from leg bags
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
ask people and/or their family members and carers to complete a 'fluid input/urine output chart' to record fluid intake, frequency of urination and volume of urine passed for a minimum of 3 days
consider measuring the urinary flow rate in people who are able to void voluntarily
measure the post-void residual urine volume by ultrasound, preferably using a portable scanner, and consider taking further measurements on different occasions to establish how bladder emptying varies at different times and in different circumstances
consider making a referral for a renal ultrasound scan in people who are at high risk of renal complications such as those with spina bifida or spinal cord injury
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