Rachel M. Shapiro, MS, PA-C, presents “Neurogenic Lower Urinary Tract Dysfunction (NLUTD): A Walk Through the Guidelines.”
How to cite: Shapiro, Rachel. “Neurogenic Lower Urinary Tract Dysfunction (NLUTD): A Walk Through the Guidelines.” September 3, 2025. Accessed Oct 2025. https://grandroundsinurology.com/neurogenic-lower-urinary-tract-dysfunction-nlutd-a-walk-through-the-guidelines/
Neurogenic Lower Urinary Tract Dysfunction (NLUTD): A Walk Through the Guidelines – Summary
Why Watch: A clear, clinic-ready walkthrough of AUA/SUFU risk stratification for Neurogenic Lower Urinary Tract Dysfunction (NLUTD) with practical surveillance schedules, treatment pathways, and case pearls for APPs.
Rachel Shapiro, PA-C, Department of Urology, UC San Diego Health, San Diego, California, explains the Neurogenic Lower Urinary Tract Dysfunction (NLUTD) guidelines, centered on protecting the upper tracts while optimizing continence and quality of life. NLUTD requires a neurologic diagnosis and may involve the bladder, bladder neck, and/or sphincter. She maps common etiologies, including congenital, acquired central nervous system disease, and spinal/peripheral lesions. Treatment has four goals: upper-tract safety, bladder safety, continence/bowel programs, and quality of life.
Care begins with a history, physical, and post-void residual (PVR) test. Patients are classified into low, unknown, or moderate vs high-risk categories, which must be continually reevaluated.
Low risk: Patients with suprapontine or distal lesions with low PVR, no prior complications, and normal imaging/renal function. Routine imaging or urodynamics is not required unless symptoms change.
Unknown risk: Patients with suprasacral spinal cord lesions, abnormal renal function, or bladder stones. They require baseline renal labs, upper-tract imaging, and urodynamics to monitor storage pressures, reflux, or poor compliance.
Moderate vs High-risk: Patients with retention/obstruction patterns vs poor compliance, elevated storage pressures, reflux, hydronephrosis, or renal impairment. Surveillance escalates with annual assessment, labs, ultrasound, renal function studies, and upper tract imaging.
Treatment options range from medications to surgical procedures and neuromodulation. Clean intermittent catheterization (CIC) is generally preferred over indwelling catheters for emptying. Shapiro emphasizes bowel optimization to lower UTI risk, tailored sexual/fertility counseling, and pragmatic scheduling to support adherence.
