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<font size="4">Consensus Statement on Neurogenic Detrusor Overactivity (NDO): Multiple Sclerosis and Spinal Cord Injury</font><br><i><font size="3">Improving Diagnosis, Management, and Treatment of NDO Through Integrated Care</i></font>

Consensus Statement on Neurogenic Detrusor Overactivity (NDO): Multiple Sclerosis and Spinal Cord Injury
Improving Diagnosis, Management, and Treatment of NDO Through Integrated Care

Format

Monograph

Time to Complete

1 hour

Released

January 10, 2013

Expires

July 10, 2013

Maximum Credits

1.00 / AMA PRA Category 1 Credit(s)TM

Accredited Provider

Jointly sponsored by the Warren Alpert Medical School of Brown University and Health and Wellness Education Partners.

Commercial Supporter

This activity is supported by an educational grant from Allergan, Inc.

Program Description

This consensus statement on neurogenic detrusor overactivity (NDO) discusses the effect of NDO on the quality of life and overall health of patients with multiple sclerosis (MS) and spinal cord injury (SCI), identifies health care provider and patient barriers to care, describes best practices to screen for urinary dysfunction, and summarizes the panel’s recommendations for management of NDO in this patient population. Management strategies include antimuscarinic agents such as oxybutynin, onabotulinumtoxinA intradetrusor injection, sacral nerve stimulation, bladder augmentation or urinary diversion, and clean intermittent catheterization. Long-term follow-up of patients with NDO is important because changes in detrusor compliance and urodynamic patterns may occur over time.

Intended Audience

This activity is designed for urologists, neurologists, physiatrists, and other health care professionals interested in or involved with the management of patients with multiple sclerosis or spinal cord injury who are at risk for neurogenic detrusor overactivity.

Educational Objectives

At the conclusion of this activity, participants should be able to:

  • Describe the effect of bladder dysfunction on health and health-related quality of life in individuals with multiple sclerosis (MS) and spinal cord injury (SCI)
  • Identify factors and barriers influencing optimal management of neurogenic detrusor overactivity (NDO) across specialties
  • Discuss the clinical aspects of NDO including its multiple etiologies, patient evaluation, varying treatment goals, and common coexisting conditions
  • Review current and future options for the management of NDO in patients with MS and SCI
  • Adopt new standards of care for multidisciplinary management of NDO in the practice setting

Conflicts of Interest Disclosure Statements

In accordance with the disclosure policy of the Warren Alpert Medical School of Brown University as well as standards set forth by the Accreditation Council for Continuing Medical Education, all individuals in a position to control the content of a CME activity are required to disclose relevant financial relationships with commercial interests (within the past 12 months). Disclosures of this activity’s faculty and planning committee have been reviewed and all identified conflicts of interest, if applicable, have been resolved.

Faculty

Pamela I. Ellsworth, MD
(Program Chair)
Associate Professor of Surgery
Division of Urology
The Warren Alpert Medical School of Brown University
Providence, RI

Pamela I. Ellsworth, MD, is a consultant/advisory board member for Allergan, Inc., Astellas Pharma US, Inc.; and Pfizer Inc. She is a speaker for Allergan, Inc. and Pfizer Inc.

Patricia K. Coyle, MD
(Program Co-Chair)
Professor and Acting Chair
Department of Neurology
Stony Brook University
Director, Stony Brook MS Comprehensive Care Center
Stony Brook, NY

Patricia K. Coyle, MD, is a consultant for Acorda Therapeutics; Avanir Pharmaceuticals, Inc.; Bayer Corporation; Biogen Idec Inc.; EMD Serono, Inc.; Novartis AG; Sanofi-Aventis U.S. LLC; and Teva Neuroscience, Inc. She has received grant/research support from Actelion Pharmaceuticals Ltd and Novartis AG.

Alberto Esquenazi, MD
(Program Co-Chair)
Professor and Chair
Department of Physical Medicine and Rehabilitation
Moss Rehab and Albert Einstein
Philadelphia, PA
Director, Gait & Motion Analysis Laboratory
Moss Rehab
Elkin Park, PA

Alberto Esquenazi, MD has received grant/research support from Allergan, Inc., and Ipsen.

Karl-Erik Andersson, MD, PhD
Professor, Institute for Regenerative Medicine
Wake Forest University
Professor, Department of Urology
Wake Forest School of Medicine
Winston-Salem, NC

Karl-Erik Andersson, MD, PhD, is a consultant for Allergan, Inc.; Astellas Pharma US, Inc.; GlaxoSmithKline plc; and Pfizer Inc.

Jack S. Burks, MD
Chief Medical Officer
Multiple Sclerosis Association of America
Cherry Hill, NJ

Jack S. Burks, MD, is a consultant and speaker for Acorda Therapeutics; Allergan, Inc.; Avanir Pharmaceuticals, Inc.; Bayer Corporation; EMD Serono, Inc.; and Novartis AG.

June Halper, NP
Adult Nurse Practitioner
Consortium of Multiple Sclerosis Centers
Hackensack, NJ
Advanced Practice Nurse
Division of Neurology
Department of Neuroscience
Multiple Sclerosis Center
University of Medicine & Dentistry of New Jersey
Newark, NJ

June Halper, NP, is a consultant for Acorda Therapeutics; Questcor Pharmaceuticals, Inc.; and Teva Neuroscience, Inc. She is a speaker for non-CME programs for Acorda Therapeutics.

Victor W. Nitti, MD
Professor and Vice Chairman
Department of Urology
Director of Female Pelvic Medicine and Reconstructive Surgery
NYU Langone Medical Center
New York, NY

Victor W. Nitti, MD, has received grant/research support from Allergan, Inc., and Astellas Pharma US, Inc. He is a consultant for Allergan, Inc.; Astellas Pharma US, Inc.; Medtronic, Inc., and Uroplasty, Inc.

William A. Sheremata, MD
Professor of Clinical Neurology
Department of Neurology
Miller School of Medicine
University of Miami
Miami, FL

William A. Sheremata, MD, has received grant/research support from Acorda Therapeutics, Novartis AG, and Roche. He is a consultant for Acorda Therapeutics, Novartis AG, and Teva Neuroscience, Inc.

David R. Staskin, MD
Associate Professor of Urology
Tufts University School of Medicine
Head, Female Urology and Neurourology
Division of Urology
Steward – St. Elizabeth’s Medical Center
Boston, MA

David R. Staskin, MD, is a consultant for Allergan, Inc.; Antares Pharma; and Astellas Pharma US, Inc. He is a speaker for Allergan, Inc.; Astellas Pharma US, Inc.; and Watson Pharmaceuticals, Inc.

Paul J. Tobin, MSW
President and CEO
United Spinal Association, Inc.
East Elmhurst, NY

Paul J. Tobin, MSW, is chief executive of the United Spinal Association, which has received grant support from Allergan, Inc.

Alan J. Wein, MD, FACS, PhD (hon)
Professor and Chief
Division of Urology
Penn Medicine, Perelman School of Medicine
Chief, Division of Urology
Penn Medicine, University of Pennsylvania Health System
Philadelphia, PA

Alan J. Wein, MD, FACS, PhD (Hon), has served as a consultant for Allergan, Inc.; Astellas Pharma US, Inc.; Endo Pharmaceut

Activity Staff Disclosures

The planners, reviewers, editors, staff, or other members at Health and Wellness Education Partners and the Alpert Medical School CME Office who control content have no relevant financial relationships to disclose.

Credit

1.00

Type

AMA PRA Category 1 Credit(s)TM

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Warren Alpert Medical School of Brown University and Health and Wellness Education Partners. The Warren Alpert Medical School is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statement

The Warren Alpert Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclaimer

This enduring material is produced for educational purposes only. Content is provided by faculty who have been selected because of recognized expertise in their field. The opinions and recommendations expressed by the faculty whose input is included in this activity are their own. The use of the Warren Alpert Medical School of Brown University name implies oversight and review by the CME Office of educational content, format, design, and approach. Participants have the professional responsibility to review the complete prescribing information of specific drugs or combination of drugs including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients. The Warren Alpert School of Medicine of Brown University assumes no liability for the information herein.

Corresponding Author
Pamela I. Ellsworth, MD

University Urological Associates
2 Dudley Street, Suite 185, Providence, RI 02908
Phone: 1-401-421-0710, ext. 1323
Fax: 1-401-421-0720
E-mail: pamelaellsworth@aol.com

Instructions

Method of Participation/CME Credit

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  • Review the Manuscript.
  • Complete the post-test and activity evaluation at the conclusion of the activity. A minimum score of 75% is required to receive a CME credit certificate.
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Warren Alpert Medical School of Brown University
Office of Continuing Medical Education
233 Richmond Street, Providence, RI 02912
Phone: 1-401-863-1208
E-mail: CME@Brown.edu

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