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Management of Neurogenic Stress Urinary Incontinence: An Updated Review

  • REVIEW
  • Published:
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Abstract

Purpose of Review

Managing neurogenic stress urinary incontinence (NSUI) remains a significant challenge. Multiple issues contribute to this, including challenges in accurate diagnosis, coexistence of bladder and bowel dysfunctions, lack of robust scientific evidence supporting various treatment modalities, the diverse preferences of patients, and the need to tailor interventions to an individual's social circumstances. This review aims to update the current alternatives for the surgical management of patients with NSUI.

Recent Findings

The scientific landscape in the field of neurogenic stress urinary incontinence (NSUI) remains constrained in terms of both volume and quality of research. In recent years, only a handful of studies have emerged, most of which are retrospective and report on a few patients and relatively short follow-up periods. These studies frequently involve heterogeneous populations and employ varied definitions of success, further complicating the interpretation of results. For women, studies have shown promising results with the use of synthetic midurethral slings and the robotic technique of implanting the artificial urinary sphincter (AUS). Autologous fascial slings continue to be viewed as one of the most appropriate techniques. For men, the robotic technique for AUS implantation at the bladder neck has become the preferred method for AUS implantation in this population. Reasonable results have been shown with male slings. While the AUS has demonstrated efficacy, there is a notable rate of device-related complications. Very limited and poor results have been reported with bulking agents and adjustable continence devices.

Summary

Managing NSUI necessitates a multidisciplinary, individualized, patient-tailored approach. Continence rates may decrease over time, and complications must be monitored. Overall, understanding the nuances of surgical options and tailoring treatments to patient needs is paramount to improve quality of life and preserve urinary tract function.

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Data Availability

The data that support the findings of this study are available as Supporting Information.

Abbreviations

ACT:

Adjustable continence therapy

AUA:

American Urology Association

AUS:

Artificial urinary sphincter

BNC:

Bladder neck closure

BNR:

Bladder neck reconstruction

CIC:

Clean intermittent catheterization

EAU:

European Association of Urology

ICS:

International Continence Society

ISD:

Intrinsic sphincter deficiency

MMC:

Myelomeningocele

NLUTD:

Neurogenic lower urinary tract dysfunction

NSUI:

Neurogenic sphincter deficiency stress urinary incontinence

PVS:

Pubovaginal autologous sling

QoL:

Quality of life

SCI:

Spinal cord injury

SMT:

Synthetic miduretral tape

SUFU:

Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

SUI:

Stress urinary incontinence

TVT:

Tension free retropubic vaginal tape

UDS:

Urodynamics study

UI:

Urinary incontinence

US:

Ultrasound

UTI:

Urinary tract infection

UUT:

Upper urinary tract

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Acknowledgements

The editors would like to thank Dr. Charles Powell for handling the review of this manuscript.

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Authors and Affiliations

  1. Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil

    Vicktor Bruno Pereira Pinto, Matheus Fagundes de Azevedo, Luísa Resende Tenório de Albuquerque & Cristiano Mendes Gomes

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Contributions

VBPP conducted a literature search and contributed to the sections on diagnosis, urinary sphincter in women, and bladder neck reconstruction and closure surgeries. VBPP also handled the structuring of tables, figures, and references. MFA conducted a literature search and drafted the section on male urinary incontinence. LRTA conducted a literature search and wrote the section on female urinary incontinence. CMG conceived and structured the paper, as well as performed a critical analysis.

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Correspondence to Cristiano Mendes Gomes.

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Pinto, V.B.P., de Azevedo, M.F., de Albuquerque, L.R.T. et al. Management of Neurogenic Stress Urinary Incontinence: An Updated Review. Curr Bladder Dysfunct Rep (2024). https://doi.org/10.1007/s11884-024-00749-3

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