4th Annual Jefferson Urology Symposium: Focus on Urinary Incontinence

© The Canadian Journal of Urology TM : International Supplement, August 2021 37 Management of neurogenic detrusor overactivity drainage of urine. We have observed some patients develop urinary stasis which can result in frequent urinary tract infections. Patient selection is critical and it is important to assure a functional bladder outlet prior to considering ileal vesicostomy to minimize the risk of urethral incontinence. Complications are similar to other types of incontinent urinary diversion including stomal stenosis, peristomal hernias, and urolithiasis. 23 Patients should be counseled regarding the significant risk of needing additional treatment or surgery following ileovesicostomy. Conclusions Patients with NDO should have life-long urologic surveillance and follow up. The extent of regular evaluation and testing should be based on the principal of risk stratification. Routine upper tract imaging and urodynamics is not indicated in NDO patients at low risk of renal and urologic complications; an example would be a patient with urge incontinence from a CVA who is adequately medically managed. In contrast, patients with worrisome storage parameters that risk upper tract damage require periodical evaluation. We recommend annual clinical assessment in patients with high riskNLUTD for assessment of symptoms, physical examination, evaluation of renal function, and upper tract imaging. The frequency of urodynamic studies in this patient population should be individualized. Treatment for NDO should be considered not only for clinical symptoms such as incontinence, but also aimed at preserving renal function. References 1. Roger VL, Go AS, Lloyd-Jones DM et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. 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