Neurogenic lower urinary tract dysfunction (NLUTD) results from abnormal bladder, bladder neck, or urethral sphincter function secondary to neurologic disease. The AUA/SUFU risk-stratified framework classifies patients as low (LR), moderate (MR), or high risk (HR) to guide management and surveillance. Using a large single-institution database, we evaluated outcomes following application of this framework in a contemporary NLUTD cohort.
After IRB approval, records of 980 patients with NLUTD managed between 2010–2025 were retrospectively reviewed; 884 had complete data. Based on AUA/SUFU criteria, 9% (n=79) were HR, 18% (n=158) MR, and 73% (n=645) LR. Median age was 52, median follow-up of 82 months, 54% male, and 46% female. Etiologies included multiple sclerosis (MS) 32% (n=283), cerebrovascular accident (CVA) 25% (n=221), spinal cord injury (SCI) 21% (n=185), lumbosacral disk disease (LSDD) 16% (n=141), and Parkinson’s disease 4% (n=35).
Bladder management included intestinal reconstruction (10%), indwelling catheter (5%), intermittent catheterization (18%), and spontaneous voiding (67%). HR/MR patients underwent annual renal US or CT and renal function testing; urodynamics (UDS) and cystoscopy were done as indicated. LR patients received studies only when necessary. Surgical interventions among HR patients included augmentation cystoplasty (38%), bladder neck closure/continent catheterizable channel (25%), incontinent diversion (12%), artificial urinary sphincter (6%), and sphincterotomy (4%); 17% underwent combined reconstruction or suprapubic (SP) catheter placement. Among MR patients, 7.5% had reconstruction, 67% received medical therapy (MT; anticholinergics and/or β3-agonists) with OnabotulinumtoxinA (BTX), and 25% MT alone. LR patients required no surgery; 33% MT+BTX, 67% MT alone. Sacral neuromodulation was not utilized. No patient developed renal deterioration, renal failure, or recurrent febrile UTI under AUA/SUFU-guided management. Overall, 89% achieved satisfactory continence.
NLUTD patients can be effectively managed using the AUA/SUFU framework, maintaining stable renal function, low UTI rates, and high continence and QoL. Multi-institutional validation is warranted.
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