This is the first study on the neurogenic detrusor overactivity incontinence with the intention of to include it in the NANDA International (NANDA-I) Nursing Diagnoses, a very known and used terminology in Nursing. Neurogenic detrusor overactivity incontinence is the loss of urine due to involuntary detrusor contraction caused by neurologic disease (1,2). It term would replace the nursing diagnosis Reflex Urinary Incontinence, included in NANDA-I in 1986 and revised in 1998, for NANDA-I to correspond with International Continence Society (ICS) terminology. Therefore, the objective of this study was to review all the elements that compound that diagnosis based on the ICS terminology and the current scientific literature to facilitate the identification of this condition by the nurses.

We performed an integrative review from 1996 to 2018, including two years prior the last review and publication of the nursing diagnosis Reflex Urinary Incontinence. The search was carried out in five databases: EMBASE, MEDLINE (PubMed), Scopus, Cinahl, Virtual Health Library and in the journals Neurourology & Urodynamics and International Journal of Nursing Knowledge. The data were collected using an instrument specifically for this study. We identified 2.328 papers and, after the exclusions, 35 articles were included in the qualitative synthesis. The nursing diagnosis is compounded by four elements, two of them essentials to characterize the phenomenon: defining characteristics (the signal and/or symptoms related or showed by the person) and related factors (cause or contributing factor, etiological factor). The others two elements, should support the nursing diagnosis and make easier its identification, they are: associated conditions (medical diagnoses, injuries, procedures, medical devices, or pharmaceutical agents, that is, conditions not independently modifiable by nurses, but that may improve the accuracy of the nursing diagnosis) and at risk populations (groups of people who share a characteristic that causes each member to be susceptible to a particular human response, such as, demographics, health/family history, stages of growth/development, or exposure to certain events/experiences) (3).

After the analysis of the collected material, 35 articles of the search were selected, which subsidized the selection of 17 defining characteristics, 11 related factors, four associated conditions and two at risk population, which compound the elements of the nursing diagnosis Neurogenic Detrusor Overactivity Incontinence. These elements are shown below.

Elements of neurogenic detrusor overactivity incontinence:
1. Defining Characteristics: Reflex voiding; Prophylactic urination; Look for a bathroom immediately when in a new place; Choose to wear clothing that wouldn’t show if you lost some urine; Avoiding sexual intimacy; Voiding is induced by sacral root electrical stimulation or by catheterisation; Frequent loss of small volumes of urine; Variable micturition volume; Post void residual; Reduced bladder sensation; Non-specific bladder sensations; Bladder sensation increased; Bladder sensation absent; Urgency urinary incontinence; Pollakisuria; Nocturia and Decreased bladder capacity;
2. Related Factors: Neurogenic detrusor overactivity; Detrusor sphincter dyssynergia (DSD); Bladder hypersensitivity; Low bladder wall compliance; Alcohol, caffeine and carbonated drinks intake; Excessive fluid intake; Restriction of fluid intake; Chronic constipation; Obesity; Vitamins C, calcium intake and Smoking;
3. Associated Conditions: Suprapontine lesions; Pontine lesions; Suprasacral spinal cord lesions and Urologic Complications;
4. At Risk Population: Obese women and Elderly people.

Reflex Urinary Incontinence is defined by NANDA-I as involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached. It has eight defining characteristics and three associated conditions. Its related factors and at risk population are in developing (3). All of these elements are different from those identified by the present review and many of them are missing. This fact brings difficulties for nurses to identify the correct diagnosis and define an adequate plan of nursing interventions. Since 2002 the ICS recommends that the terms “motor urge incontinence”' and “reflex incontinence'', should no longer be used as they have no intuitive meaning and are often misused (1). The use of standardizing terminologies can make the diagnosis inferences easier and precise, and facilitate the communication between the health professionals involving in the patient care, but they need to be updated. Therefore, periodic reviews, like the present, are necessary.

Through an integrative review based on the specialized literature, it was possible to identify new defining characteristics, related factors and other elements that support the diagnosis inferences for the nursing diagnosis Reflex Urinary Incontinence. In addition, we also suggest reviewing the title of this nursing diagnosis to become it more adequate. Our suggestion is Neurogenic Detrusor Overactivity Incontinence.

Abrams P, Cardozo L, Fall M, Griffiths D, Rosler P, Ulmsten U et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002; 21(2): 167-78.
Drake MJ, Apostolidis A, Cocci A, Emmanuel A, Gajewski JB, Harrison SCW, Heesakkers JPFA, Lemack, Madersbacher H, Panicker JN, Radziszewski P, Sakakibara R, Wyndaele JJ. Neurogenic Lower Urinary Tract Dysfunction: Clinical Management Recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence 2013. Neurourol Urodynam. 2016; 35:657–65.
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