Introduction: Neurogenic lower urinary tract dysfunction (NLUTD) is challenging to treat. Urological complications, such as infection, stones, and renal failure, mean that many patients require urological surveillance. The Canadian Urological Association (CUA) neurogenic bladder guideline presents a framework for followup of NLUTD, however, there has been no formal evaluation of how this framework may function in the real world. Our objective was to evaluate the effectiveness of the proposed risk stratification system.

Methods: This is a prospective, two-center, observational cohort study. Adult NLUTD patients who required urodynamics were offered enrollment. They underwent standardized medical history and questionnaires; the most recent renal imaging and renal function measurements were obtained. Patients with a requirement for immediate bladder surgery (not suitable for surveillance) were excluded. The primary outcome was the correlation between risk category and the need for urological management. Chi-squared and t-test were used.

Results: There were 68 patients enrolled. NLUTD etiology was spinal cord injury (SCI) (78%), multiple sclerosis (MS) (17.6%), and spinal bifida (SB) (4.4%); 46% of SCI patients had a cervical SCI. Most patients used clean intermittent catheterization (CIC) (63.6%), followed by voiding (16.7%) and indwelling urethral catheter (4.5%). At baseline, 62% were classified as high-risk and 38% as medium-risk, as per the CUA guideline. Comparing the high-risk to the medium-risk group, a greater proportion were recommended new bladder medications (43% vs. 30%, p=0.32), intravesical onabotulinum toxin (49% vs. 30%, p=0.16), or change in bladder management (35% vs. 26%, p=0.46). There was no difference in the mean Neurogenic Bladder Symptom Score (SF) between both groups (11.8 vs 12.3, p=0.80).

Conclusions: While not statistically significant, there was a consistent trend towards the CUA high-risk group being offered more interventions compared to the medium-risk group. Importantly, these two groups cannot be differentiated based on symptom burden. Longitudinal followup is planned.