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Current concepts and investigations in LUTS management

Urodynamics, the link between LUTS and progressive neurogenic disease, and polypharmacy were some of the topics deliberated during the well-attended Plenary Session 4 “Contemporary storage Lower Urinary Tract Symptoms (LUTS) management”, which was chaired by Prof. F.C. Fiona Burkhard (CH) and Prof. Chris Chapple GB).

Urodynamics

“In neurology, there are two main goals: to protect the upper urinary tract and to improve the patients’ quality of life,” stated Prof. Dr. Thomas Kessler (CH). In his lecture “Lower Urinary Tract Symptoms (LUTS) and stable neurogenic disease”, he defined Urodynamics as a tool to assess the function of the lower urinary tract and to secure the upper urinary tract. Kessler said, “Solving a patient’s symptoms does not also mean also saving the upper urinary tract.”

According to Kessler, neurourology is a balancing act. “You have to individualise the management of your patients. Can the patient walk without assistance or is he on a wheelchair? But even then, the latter could have a very active lifestyle. Customised treatment is key; one size does not fit all.”

Progressive neurogenic disease

“LUTS change as the patient’s conditions evolve,” said Dr. Xavier Gamé (FR) in his lecture “LUTS and progressive neurogenic disease”. Gamé added that adapted management to different symptoms are available. He stated that follow-up is required to assess LUTS changes and to screen complications in MS patients.

Polypharmacy

According to Dr. Adrian Wagg (CA), there is little evidence for the link between polypharmacy and overactive bladder (OAB), but more for undifferentiated incontinence. “Polypharmacy makes urinary incontinence more likely,” said Wagg. In his lecture “Age, polypharmacy and OAB”, he stated that when OAB drugs and other antimuscarinics are combined, these contribute to an overall anticholinergic burden. He said that this should be reduced where possible. Additionally, Wagg said that a formal, contextual medication review may help.