Current Bladder Dysfunction Reports

, Volume 13, Issue 4, pp 191–200 | Cite as

Neurogenic Bladder: Recurrent Urinary Tract Infections—Beyond Antibiotics

  • Alison C. Castle
  • Albert Park
  • Alissa J. Mitchell
  • Donna Z. Bliss
  • Jeffrey A. Gelfand
  • Elise J. B. De
Inflammatory/Infectious Bladder Disorders (MS Mourad, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Inflammatory/Infectious Bladder Disorders


Purpose of Review

Our goal was to identify evidenced-based strategies to prevent and treat patients with neurogenic bladder who suffer from recurrent urinary tract infections. We focused on therapy beyond standard antibiotics to address a multitude of factors implicated in these complex infections.

Recent Findings

Anatomic and functional components specific to neurogenic bladder contribute to the risk of infection and require close clinical monitoring. The host-pathogen interaction is one that allows for colonization of bacteria in the bladder. We recognize that bacteriuria in the neurogenic bladder population does not equate with infection. Local antibiotic treatment and oral supplements are often not adequate to eliminate infection nor prevent recurrent infection due to biofilms. However, novel medical therapies, such as photodynamic therapy, bacterial interference, and infrared laser therapy to augment local immune cells, are promising options to prevent and treat symptomatic infection.


A combination approach including management of anatomic and functional factors with medical intervention can significantly improve frequency of urinary infection. Further study of non-antibiotic therapeutic strategies is much needed as we recognize the complexity of the urinary biomes and the limitations of antibiotic therapies.


Neurogenic bladder Neurogenic UTI Recurrent urinary tract infection Catheter-associated UTI 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Alison C. Castle
    • 1
  • Albert Park
    • 2
    • 3
  • Alissa J. Mitchell
    • 2
  • Donna Z. Bliss
    • 4
  • Jeffrey A. Gelfand
    • 1
    • 5
  • Elise J. B. De
    • 2
    • 6
  1. 1.Department of MedicineMassachusetts General HospitalBostonUSA
  2. 2.Department of UrologyMassachusetts General HospitalBostonUSA
  3. 3.Department of Physical Medicine and RehabilitationSpaulding Rehabilitation HospitalBostonUSA
  4. 4.School of NursingUniversity of MinnesotaMinneapolisUSA
  5. 5.Division of Infectious DiseaseMassachusetts General HospitalBostonUSA
  6. 6.Spaulding Rehabilitation NetworkMassachusetts General HospitalBostonUSA

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