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Inicio Actas Urológicas Españolas (English Edition) A systematic review of the diagnosis and treatment of patients with neurogenic h...
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Vol. 42. Issue 1.
Pages 5-16 (January - February 2018)
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Vol. 42. Issue 1.
Pages 5-16 (January - February 2018)
Review article
A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle
Diagnóstico y tratamiento del paciente con hiperactividad neurogénica del músculo detrusor. Revisión sistemática
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A. Boraua,
Corresponding author
aborau@medular.org

Corresponding author.
, J.M. Adotb, M. Alluéc, S. Arlandisd, D. Castroe, M. Estebanf, J. Salinasg
a Fundación del Lesionado Medular-Aspaym, Madrid, Spain
b Servicio de Urología, Hospital General Universitario, Burgos, Spain
c Servicio de Urología, Hospital Universitario Vall d’Hebron, Barcelona, Spain
d Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
e Servicio de Urología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
f Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, Spain
g Servicio de Urología, Hospital Clínico San Carlos, Madrid, Spain
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Tables (5)
Table 1. Recommendations on maneuvers facilitating bladder emptying.
Table 2. Pharmacological treatments available for the NDO approach.
Table 3. Recommendations on therapeutic alternatives in patients with NDO.
Table 4. Recommendations on follow-up tools for patients with neurogenic detrusor overactivity.
Table 5. Recommendations on the periodic follow-up of patients with neurogenic detrusor overactivity.
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Abstract
Background

Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterized by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH.

Objective

The aim of this study is to standardize the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalized medical care.

Acquisition of evidence

We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists.

Synthesis of the evidence

In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients’ continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalized based on each patient's needs.

Conclusions

The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients’ quality of life.

Keywords:
Neurogenic bladder
Consensus
Clinical practice guidelines
Resumen
Introducción

La hiperactividad neurogénica del detrusor (HND) es una observación urodinámica caracterizada por contracciones involuntarias del detrusor durante la fase de llenado causada por una enfermedad neurológica subyacente. Las complicaciones frecuentes y graves que pueden derivar de la HND aconsejan la elaboración de protocolos asistenciales para el correcto manejo de enfermos con HND.

Objetivo

El propósito de este trabajo es homogeneizar criterios para la toma de decisiones en el manejo de pacientes con diagnóstico o sospecha de HND, prestando atención a la medicina personalizada.

Adquisición de la evidencia

Se realizó una revisión sistemática no exhaustiva de la literatura sobre aspectos del diagnóstico y tratamiento de la HND; a partir de ella, se emitieron recomendaciones por consenso nominal de un grupo de especialistas en Urología.

Síntesis de la evidencia

En general, el diagnóstico de HND vendrá dado por una correcta historia clínica, la exploración física y el diario miccional antes de realizar cualquier investigación diagnóstica. Los objetivos principales del tratamiento son proteger el tracto urinario superior, restaurar la función del tracto inferior y mejorar la continencia y la calidad de vida de estos pacientes. El tratamiento consiste en varios escalones encaminados a obtener un correcto almacenamiento vesical que permita micciones suficientemente espaciadas en el tiempo. El seguimiento debe personalizarse según las necesidades de cada paciente.

Conclusiones

La identificación y el manejo de la HND resultan importantes para reconducir positivamente la función del tracto urinario inferior, en cuanto a llenado y vaciado, y mejorar la calidad de vida de los pacientes con HND.

Palabras clave:
Vejiga urinaria neurógena
Consenso
Guía de práctica clínica

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