From the Guidelines
Treatment for neurogenic bladder should prioritize clean intermittent catheterization (CIC) as the cornerstone of management, supplemented by medications such as anticholinergics and beta-3 agonists, and considering more invasive options like sacral neuromodulation or surgical interventions based on individual patient needs and risk stratification. When considering treatment options, it's essential to evaluate the patient's level of risk, symptoms, and urodynamic findings, as outlined in the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up 1. Key treatment strategies include:
- Behavioral techniques such as timed voiding, double voiding, and pelvic floor exercises
- Clean intermittent catheterization (CIC) performed 4-6 times daily using sterile technique, which is associated with a lower incidence of UTI and asymptomatic bacteriuria 1
- Medications like anticholinergics (e.g., oxybutynin, tolterodine, solifenacin) and beta-3 agonists (e.g., mirabegron) to relax the bladder and reduce overactivity
- Botulinum toxin injections into the bladder wall for refractory cases
- More invasive options like sacral neuromodulation and surgical interventions (e.g., bladder augmentation, urinary diversion) for severe cases. The choice of treatment should be guided by the underlying cause of neurogenic bladder, the specific bladder dysfunction pattern, and the patient's functional status and preferences, with a focus on minimizing morbidity, mortality, and improving quality of life.
From the FDA Drug Label
Oxybutynin chloride is indicated for the relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder (i.e., urgency, frequency, urinary leakage, urge incontinence, dysuria). BOTOX is a prescription medicine that is injected into muscles and used: to treat leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease when another type of medicine (anticholinergic) does not work well enough or cannot be taken. The treatment options for neurogenic bladder include:
- Oxybutynin (2) for the relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder
- OnabotulinumtoxinA (BOTOX) (3) to treat leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease when another type of medicine (anticholinergic) does not work well enough or cannot be taken.
From the Research
Treatment Options for Neurogenic Bladder
The treatment options for neurogenic bladder can be categorized into several approaches, including:
- Medications: such as antimuscarinics to reduce bladder spasms and improve bladder capacity 4
- Intermittent catheterization: to empty the bladder and prevent urinary tract infections 5, 6
- Bladder augmentation: a surgical procedure to increase bladder capacity and reduce bladder pressure 4, 5, 7
- Urinary diversion: a surgical procedure to divert urine flow away from the bladder 7
- Neuromodulation: a treatment that uses electrical impulses to regulate bladder function 7
- OnabotulinumtoxinA injections: to relax the bladder muscle and reduce spasms 4
Surgical Interventions
Surgical interventions, such as bladder augmentation and urinary diversion, are typically considered for patients with refractory neurogenic bladder who have failed other treatments 4, 5, 7. These procedures can provide durable clinical and urodynamic improvement, as well as high patient satisfaction 5.
Follow-up and Management
Follow-up urodynamics is an essential component of neurogenic bladder management, as it can help identify patients at risk of secondary upper urinary tract damage and prevent renal dysfunction 6. A management algorithm that incorporates follow-up urodynamics, intermittent catheterization, and medications can improve patient care and quality of life 6, 8.
Anatomical Considerations
The management of neurogenic bladder should take into account the anatomical aspects of the bladder and its neural control, including the pontine micturition center and Onuf's nucleus 8. A comprehensive understanding of these anatomical considerations can inform the development of effective treatment strategies for neurogenic bladder.