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Non-surgical urologic management of neurogenic bladder after spinal cord injury

Abstract

Purpose

To review the available data on non-surgical management for neurogenic bladder in patients with spinal cord injury (SCI). Before the introduction of urinary catheters and antibiotics, neurogenic bladder was one of the main culprits for death in those patients with SCI. Currently, the management of neurogenic bladder is focused in improving quality of life and preserving renal function.

Methods

A literature review was performed and therapeutic management for neurogenic bladder was divided in six sections: (1) intermittent bladder catheterization; (2) indwelling catheters; (3) condom catheter drainage; (4) reflex voiding and bladder expression with Valsalva or Credé; (5) oral drug therapy of the spinal cord injured bladder; and (6) botulinum neurotoxin (BoNT).

Results

Intermittent catheterization is recommended as the preferable method for management of neurogenic bladder in patients with SCI based on limited high-quality data. However, this may not be feasible or available to all and other alternative options include condom catheter drainage or indwelling catheters such as urethral catheters or suprapubic tube, reflex voiding, and bladder expression with Valsalva or Credé. Non-invasive medical therapies are the key to improve incontinence, urodynamic parameters, and quality of life in this population. Botulinum neurotoxin has revolutionized the management of neurogenic bladder in the last two decades decreasing the need for reconstruction or diversion.

Conclusion

The Joint SIU-ICUD (Société Internationale d’Urologie) (International Consultation on Urological Diseases) International Consultation reviewed the available presented data and provided specific conclusions and recommendations for each non-surgical urologic method to address neurogenic bladder after SCI.

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All the authors whose names appear on the submission have contributed sufficiently and consented to submit this article for publication as specified below: PGBR: data collection or management, data analysis, manuscript writing, and editing. CPS, AC, MAA, CD, CB, and PM: data collection or management, data analysis, and manuscript writing. SD: data management and analysis, and manuscript editing. APC: project development, data collection or management, data analysis, manuscript writing, and editing.

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Correspondence to Anne P. Cameron.

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Conflict of interest

The authors who reported conflict of interests were: Paholo G. Barboglio Romo: Co-Investigator for Covance/Ipsen. Márcio A. Averbeck: co-investigator for Covance/Ipsen; honorarium/proctor for Coloplast, Medtronic, GSK.

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Anne P. Cameron: principal investigator for Medtronic (unpaid); speaker for Wellspect. Research consisted in literature review, data collection did not involve human or animal participants, and no informed consent was utilized.

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Romo, P.G.B., Smith, C.P., Cox, A. et al. Non-surgical urologic management of neurogenic bladder after spinal cord injury. World J Urol 36, 1555–1568 (2018). https://doi.org/10.1007/s00345-018-2419-z

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  • DOI: https://doi.org/10.1007/s00345-018-2419-z

Keywords

  • Neurogenic bladder
  • Anticholinergics
  • Botulinum toxin
  • Self-catheterization