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Lower urinary tract dysfunction in neuroinflammatory diseases

      Lower urinary tract (LUT) dysfunction is a commonly reported sequelae of neuroinflammatory disorders such as Multiple sclerosis, NMO spectrum disorders and MOG associated transverse myelitis, and have a significant impact on quality of life. The pattern of LUT dysfunction is influenced by the site of neurological lesion and patients may present with storage and/or voiding dysfunction. The risk for developing upper urinary tract damage is considerably lower, compared to other disorders such as spinal cord injury or spina bifida. History taking forms the cornerstone of assessment, and urinalysis, ultrasonography and urodynamics provide information about the cause and nature of LUT dysfunction. Antimuscarinic agents are the first line management of urinary incontinence, however the side effect profile and anticholinergic burden should be considered when prescribing these medications. Beta-3 receptor agonists are a promising alternative oral medication. Tibial and sacral neuromodulation have been shown to be effective for managing neurogenic incontinence. Intradetrusor injections of onabotulinumtoxinA have revolutionised the management of neurogenic detrusor overactivity. Patients with neuroinflammatory disorders reporting LUT symptoms require a comprehensive evaluation for planning a patient-tailored approach to management.
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