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Page 10 of 13 Alsulihem et al. Neuroimmunol Neuroinflammation 2019;6:13 I http://dx.doi.org/10.20517/2347-8659.2019.007

Other incontinent urinary diversion includes ileovesicostomy, which avoids ureteric reimplantation and
cystectomy and related complications but has the disadvantage of leaving a bladder segment, which can
increase the risk of malignancy or urethral incontinence [8,46,47,52] . It can be considered in select patients.
[8]
Robust long-term results and quality of life data are lacking . Reported complications include impaired
bladder emptying, urethral incontinence, stomal stenosis, parastomal hernia, and urolithiasis [8,46,53-56] .

Therefore, monitoring patients postoperatively is essential to detect complications, and surveillance is of
paramount importance.

Monitoring, follow up, and surveillance
We recommend regular and tight surveillance after initial management, with clinical history, physical
examination, and urodynamic evaluation after initiation of any intervention, to monitor response and to
determine successful treatment and need for augmentation of medication dose or considering alternative
management option. The time between the visit should be within 2-3 months after the initiation of
medications or botulinum toxin A injection [8,12,40] . After controlling poor urodynamic features, annual
follow up of symptoms, renal function, and upper tract ultrasound are recommended [6,8,13] . Repeat
urodynamic and cystoscopy is recommended after a change in the clinical course, such as new incontinence
[6]
or recurrent urinary tract infections .
Urinary tract related factors impacting the quality of life in SCI patients
Quality of life (QOL) in SCI was found to be associated with a poorly managed urinary tract. Worse QOL
scores were found to be associated with urinary incontinence and recurrent UTIs [57-59] . Well managed
bladder with surgery and indwelling catheters had better QOL scores than patients who use clean IC .
[58]
[58]
Worst QOL scores were associated with SCI patients who do not use catheters and leak on diapers . This
emphasizes the importance of proper management of urinary incontinence in SCI patients to improve their
quality of life.

CONCLUSION
NDO secondary to SCI has a significant impact on patient quality of life, morbidity , and mortality. Early
detailed evaluation and timely intervention are of paramount importance to avoid its long-term sequelae.
Patients should be aware of the possible risks and benefits of each management option, and physicians
should keep patients under close monitoring to act early upon any changes in patients’ course of the
disease. Research in NDO should continue to address several poorly studies areas in pathophysiology,
treatments, and surveillance, as most of the available recommendations in this filed are largely based on
retrospective studies.

DECLARATIONS
Authors’ contributions
Wrote the first draft of the manuscript: Alsulihem A
Reviewed and edited the final manuscript: Corcos J

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.