Neuro-Urology pp 193-206 | Cite as


  • Riyad Taher Al-Mousa
  • Hashim Hashim


Normal micturition is a complex process that is controlled by the neural integration between the central and peripheral nervous systems to coordinate sympathetic, parasympathetic, and somatic nervous system activity to allow for normal micturition and urinary continence. Any neurological or mechanical abnormalities in this circuit may result in lower urinary tract dysfunction. Various neurological conditions can cause neurogenic lower urinary tract dysfunction. The degree of dysfunction and severity of symptoms are highly dependent on the nature, location, and extent of the neurological disease, and depending on the level of the injury, different types of urinary incontinence can be experienced.

Neurogenic lower urinary tract dysfunction and urinary incontinence negatively affect the social, psychological, financial, and quality of life of neurological patients. Treatment is aimed at protecting the upper urinary tracts and improving quality of life and should follow a pathway starting with conservative and medical therapy and then progressing to minimally invasive surgery with major surgery left as a last resort. The main aim of treatment in NLUTD is to individualize and tailor it to the needs of the patient.


Incontinence Urgency Stress Bladder Micturition Enuresis 


  1. 1.
    Del Popolo G, Panariello G, Del Croso F, et al. Diagnosis and therapy for neurogenic bladder dysfunctions in multiple sclerosis patients. Neurol Sci. 2008;29(suppl 4):S352–5. Scholar
  2. 2.
    Kaplan SA, Chancellor MB, Blaivas JG. Bladder and sphincter behavior in patients with spinal cord lesions. J Urol. 1991;146:113–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Dorsher PT, McIntosh PM. Neurogenic bladder [published online February 8, 2012]. Adv Urol. 2012;2012:816274. Scholar
  4. 4.
    Lansang RS, Krouskop AC. Bladder management. In: Massagli TL, et al., editors. eMedicine; 2004.Google Scholar
  5. 5.
    Verhoef M, Lurvink M, Barf HA, et al. High prevalence of incontinence among young adults with spina bifida: description, prediction and problem perception. Spinal Cord. 2005;43:331–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Blok B, Pannek J, Castro-Diaz D et al. EAU Guidelines on Neuro-Urology. 2015. Accessed Mar 2015.
  7. 7.
    Manack A, Mostko SP, Haag-Molkenteller, et al. Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. NeurourolUrodyn. 2011;30:395–401.Google Scholar
  8. 8.
    Linsenmeyer TA, Culkin D. APS recommendations for the urological evaluation of patients with spinal cord injury. J Spinal Cord Med. 1999;22:139–42.CrossRefPubMedGoogle Scholar
  9. 9.
    Griffiths D, Derbyshire S, Stenger A, Resnick N. Brain control of normal and overactive bladder. J Urol. 2005;174(5):1862–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Panicker JN, de Seze M, Fowler CJ, et al. Rehabilitation in practice: neurogenic lower urinary tract dysfunction and its management. Clin Rehabil. 2010;24:579–89.CrossRefPubMedGoogle Scholar
  11. 11.
    Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9:453–66.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ouslander JG. Management of overactive bladder. N Engl J Med. 2004;350(8):786–99.CrossRefPubMedGoogle Scholar
  13. 13.
    Al-Shukri SA. Neurogenic bladder-assessment, investigation, and treatment. Eur Urol Rev. 2012;7:55–60.Google Scholar
  14. 14.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the inter-national continence society. NeurourolUrodyn. 2002;21(2):167–78.Google Scholar
  15. 15.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. NeurourolUrodyn. 2010;29(1):4–20.Google Scholar
  16. 16.
    Dursun M, Otunctemur A, Ozbek E, Sahin S, Besiroglu H, Koklu I. Stress urinary incontinence and visceral adipose index: a new risk parameter. Int Urol Nephrol. 2014;46(12):2297–300.CrossRefPubMedGoogle Scholar
  17. 17.
    Vissers D, Neels H, Vermandel A, De Wachter S, Tjalma WA, Wyndaele JJ, et al. The effect of non-surgical weight loss interventions on urinary incontinence in overweight women: a systematic review and meta-analysis. Obes Rev. 2014;15(7):610–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Lenherr SM, Clemens JQ, Braffett BH, Dunn RL, Cleary PA, Kim C, et al. Glycaemic control and risk of incident urinary incontinence in women with type 1 diabetes: results from the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study (DCCT/EDIC). Diabet Med. 2016;33(11):1528–35.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Ahn KS, Hong HP, Kweon HJ, Ahn AL, Oh EJ, Choi JK, et al. Correlation between overactive bladder syndrome and obsessive compulsive disorder in women. Korean J Fam Med. 2016;37(1):25–30.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Walid MS. Prevalence of urinary incontinence in female residents of American nursing homes and association with neuropsychiatric disorders. J Clin Med Res. 2009;1(1):37–9.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Nygaard IE, Shaw JM, Bardsley T, Egger MJ. Lifetime physical activity and female stress urinary incontinence. Am J Obstet Gynecol. 2015;213(1):40.e1–10.CrossRefGoogle Scholar
  22. 22.
    Sheyn D, James RL, Taylor AK, Sam-marco AG, Benchek P, Mahajan ST. Tobacco use as a risk factor for reoperation in patients with stress urinary incontinence: a multi-institutional electronic medical record database analysis. Int Urogynecol J. 2015;26(9):1379–84.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    DuBeau CE. The continuum of urinary incontinence in an aging population. Geriatrics. 2002;57(Suppl 1):S12–7.Google Scholar
  24. 24.
    Jensen JK, Nielsen FR Jr, Ostergard DR. The role of patient history in the diagnosis of urinary incontinence. Obstet Gynecol. 1994;83(5 Pt 2):904–10.PubMedGoogle Scholar
  25. 25.
    Schurch B, Schmid DM, Karsenty G, Reitz A. Can neurologic examination predict type of detrusor sphincter-dyssynergia in patients with spinal cord injury? Urology. 2005;65:243–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Abrams P, Agarwal M, Drake M, et al. A proposed guideline for the urological management of patients with spinal cord injury. BJU Int. 2008;101:989–94.CrossRefPubMedGoogle Scholar
  27. 27.
    Wyndaele JJ, De Sy WA. Correlation between the findings of a clinical neurological examination and the urodynamic dysfunction in children with myelodysplasia. J Urol. 1985;133:638–40.CrossRefPubMedGoogle Scholar
  28. 28.
    Hill TC, Baverstock R, Carlson KV, Estey EP, Gray GJ, Hill DC, Ho C, McGinnis RH, Moore K, Parmar R. Best practices for the treatment and prevention of urinary tract infection in the spinal cord injured population: the Alberta context. Can Urol Assoc J. 2013;7(3- 4):122–30.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Drake MJ. Re: influences on renal function in chronic spinal cord injured patients. J Urol. 2001;165(6 Pt 1):2006.CrossRefPubMedGoogle Scholar
  30. 30.
    Bright E, Cotterill N, Drake M, Abrams P. Developing and validating the international consultation on incontinence questionnaire bladder diary. Eur Urol. 2014;66:294–300.CrossRefPubMedGoogle Scholar
  31. 31.
    Wyndaele JJ. A critical review of urodynamic investigations in spinal cord injury patients. Paraplegia. 1984;22:138–44.PubMedGoogle Scholar
  32. 32.
    Nitti VW, Adler H, Combs AJ. The role of urodynamics in the evaluation of voiding dysfunction in men after cerebrovascular accident. J Urol. 1996;155:263–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Hamid R, Bycroft J, Arya M, Shah PJ. Screening cystoscopy and biopsy in patients with neuropathic bladder and chronic suprapubic indwelling catheters: is it valid? J Urol. 2003;170:425–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Sammer U, Walter M, Knüpfer SC, Mehnert U, Bode-Lesniewska B, Kessler TM. Do we need surveillance Urethro-cystoscopy in patients with neurogenic lower urinary tract dysfunction? PLoS One. 2015;10(10):e0140970.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Lucas MG, Bosch RJ, Burkhard FC, Cruz F, Madden TB, Nambiar AK, et al. EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol. 2012;62(6):1130–42. Erratum in: Eur Urol. 2013;64(1):e20CrossRefPubMedGoogle Scholar
  36. 36.
    Bothig R, Hirschfeld S, Thietje R. Quality of life and urological morbidity in tetraplegics with artificial ventilation managed with suprapubic or intermittent catheterisation. Spinal Cord. 2012;50:247–51.CrossRefPubMedGoogle Scholar
  37. 37.
    Cameron AP, Wallner LP, Forchheimer MB, et al. Medical and psychosocial complications associated with method of bladder management after traumatic spinal cord injury. Arch Phys Med Rehabil. 2011;92:449–56.CrossRefPubMedGoogle Scholar
  38. 38.
    Di Benedetto P. Clean intermittent self-catheterization in neuro-urology. Eur J Phys Rehabil Med. 2011;47:651–9.PubMedGoogle Scholar
  39. 39.
    Kochakarn W, Ratana-Olarn K, Lertsithichai P, Roongreungsilp U. Follow-up of long-term treatment with clean intermittent catheterization for neurogenic bladder in children. Asian J Surg. 2004;27:134–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Gajewski JB, Awad SA. Oxybutynin versus propantheline in patients with multiple sclerosis and detrusor hyperreflexia. J Urol. 1986;135:966–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Lee JH, Kim KR, Lee YS, Han SW, Kim KS, Song SH, Baek M, Park K. Efficacy, tolerability, and safety of oxybutynin chloride in pediatricneurogenic bladder with spinal dysraphism: a retrospective, multicenter, observational study. Korean J Urol. 2014;55(12):828–33.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Mazo EB, Krivoborodov GG, Shkol’nikov ME, Babanina GA, Kozyrev SV, Korshunov ES. Trospium chloride in the treatment of idiopathic and neurogenic detrusor overactivity. Urologiia. 2005:56–9.Google Scholar
  43. 43.
    Mazo EB, Babanina GA. Trospium chloride (spasmex) in the treatment of lower urinary tract symptoms in patients with neurogenic hyperactive urinary bladder caused by vertebrogenic lesions. Urologiia. 2007:15–9.Google Scholar
  44. 44.
    van Rey F, Heesakkers J. Solifenacin in multiple sclerosis patients with overactive bladder: a prospective study. Adv Urol. 2011;2011:834753.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Krebs J, Pannek J. Effects of Solifenacin in patients with neurogenic detrusor overactivity as a result of spinal cord lesion. Spinal Cord. 2013;51:306–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Nicholas RS, Friede T, Hollis S, Young CA. Anticholinergics for urinary symptoms in multiple sclerosis. Cochrane Database Syst Rev. 2009;(1):CD004193.Google Scholar
  47. 47.
    Wöllner J, Pannek J. Initial experience with the treatment of neurogenic detrusor overactivity with a new beta-3 agonist (Mirabegron) in patients with spinal cord injury. Spinal Cord. 2016;54(1):78–82.CrossRefPubMedGoogle Scholar
  48. 48.
    Stankovich E, Borisov VV, Demina TL. Tamsulosin in the treatment of detrusor sphincter dyssynergia of the urinary bladder in patients with multiple sclerosis. Urologia. 2004:48–51.Google Scholar
  49. 49.
    Abrams P, Amarenco G, Bakke A, Buczynski A, Castro-Diaz D, Harrison S, et al. Tamsulosin: efficacy and safety in patients with neurogenic lower urinary tract dysfunction due to suprasacral spinal cord injury. J Urol. 2003;170:1242–51.CrossRefPubMedGoogle Scholar
  50. 50.
    Karsenty G, Denys P, et al. Botulinum toxin A (Botox) intradetrusor injections in adults with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic literature review. Eur Urol. 2008;53(2):275–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Apostolidis A, Dasgupta P, Denys P, Elneil S, Fowler CJ, Giannantoni A, et al. Recommendations on the use of botulinum toxin in the treatment of lower urinary tract disorders and pelvic floor dysfunctions: a European consensus panel report. Eur Urol 2009;55:100-120.Google Scholar
  52. 52.
    Mangera A, Andersson KE, Apostolidis A, Chapple C, Dasgupta P, Giannantoni A, et al. Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA). Eur Urol. 2011;60(4):784–95.CrossRefPubMedGoogle Scholar
  53. 53.
    Duthie JB, Vincent M, Herbison GP, Wilson DI, Wilson D. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev. 2011;12:CD005493.Google Scholar
  54. 54.
    Mangera A, Apostolidis A, Andersson KE, Dasgupta P, Giannantoni A, Roehrborn C, et al. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol. 2014;65(5):981–90.CrossRefPubMedGoogle Scholar
  55. 55.
    Zhang R, Xu Y, Yang S, Liang H, Zhang Y, Liu Y. OnabotulinumtoxinA for neurogenic detrusor overactivity and dose differences: a systematic review. Int Braz J Urol. 2015;41(2):207–19.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Schurch B, de Seze M, Denys P, Chartier- Kastler E, Haab F, Everaert K, et al. Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J Urol. 2005;174(1):196–200.CrossRefPubMedGoogle Scholar
  57. 57.
    Giannantoni A, Di Stasi SM, Stephen RL, Bini V, Konstantini E, Porena M. Intravesical resiniferatoxin versus botulinum-A toxin injections for neurogenic detrusor overactivity: a prospective randomized study. J Urol. 2004;172(1):240–3.CrossRefPubMedGoogle Scholar
  58. 58.
    de Seze M, Petit H, Gallien P, de Seze MP, Joseph PA, Mazaux JM, et al. Botulinum a toxin and detrusor sphincter dyssynergia: a double blind lidocaine-controlled study in 13 patients with spinal cord disease. Eur Urol. 2002;42(1):56–62.CrossRefPubMedGoogle Scholar
  59. 59.
    Gallien P, Reymann JM, Amarenco G, Nicolas B, de Seze M, Bellissant E. Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients. J Neurol Neurosurg Psychiatry. 2005;76(12):1670–6.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, Lycklama a Nijholt AA, Siegel S, Jonas U, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007;178:2029–34.CrossRefPubMedGoogle Scholar
  61. 61.
    de Seze M, Raibaut P, Gallien P, et al. Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study. NeurourolUrodyn. 2011;30:306–11.Google Scholar
  62. 62.
    Hagerty JA, Richards I, Kaplan WE. Intravesical electrotherapy for neurogenic bladder dysfunction: a 22-year experience. J Urol. 2007;178:1680–3.CrossRefPubMedGoogle Scholar
  63. 63.
    Vodusek DB, Light JK, Libby JM. Detrusor inhibition induced by stimulation of pudendal nerve afferents. NeurourolUrodyn. 1986;5:381–90.Google Scholar
  64. 64.
    Chartier-Kastler EJ, Ruud Bosch JL, Perrigot M, Chancellor MB, Richard F, Denys P. Long term results of sacral nerve stimulation (S3) for the treatment of neurogenic refractory urge incontinence related to detrusor hyperreflexia. J Urol. 2000;164:1476–80.CrossRefPubMedGoogle Scholar
  65. 65.
    Bosch RJL, Groen J. Neuromodulation: urodynamic effects of sacral (S3) spinal nerve stimulation in patients with detrusor instability or detrusor hyperflexia. Behav Brain Res. 1998;92:141–50.CrossRefPubMedGoogle Scholar
  66. 66.
    Zvara P, Sahi S, Hassouna MM. An animal model for the neuromodulation of neurogenic bladder dysfunction. Br J Urol. 1998;82:267–71.CrossRefPubMedGoogle Scholar
  67. 67.
    Kessler TM, Burkhard FC, Z’Brun S, Stibal A, Studer UE, Hess CW, et al. Effect of thalamic deep brain stimulation on lower urinary tract function. Eur Urol. 2008;53:607–12.CrossRefPubMedGoogle Scholar
  68. 68.
    Blok BF, Groen J, Bosch JL, Veltman DJ, Lammertsma AA. Different brain effects during chronic and acute sacral neuromodulation in urge incontinent patients with implanted neurostimulators. BJU Int. 2006;98:1238–43.CrossRefGoogle Scholar
  69. 69.
    Colli J, Lloyd LK. Bladder neck closure and suprapubic catheter placement as definitive management of neurogenic bladder. J Spinal Cord Med. 2011;34(3):273–7.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Westney OL, Lee JT, McGuire EJ, Palmer JL, Cespedes RD, Amundsen CL. Long-term results of Ingelman-Sundberg denervation procedure for urge incontinence refractory to medical therapy. J Urol. 2002;168:1044–7.CrossRefPubMedGoogle Scholar
  71. 71.
    Cespedes RD, Cross CA, McGuire EJ. Modified Ingelman-Sundberg bladder denervation procedure for intractable urge incontinence. J Urol. 1996;156:1744–7.CrossRefPubMedGoogle Scholar
  72. 72.
    Ross JC, Damanski M, Giddons N. Resection of the external urethral sphincter in the paraplegic- preliminary report. J Urol. 1958;79:742–6.CrossRefPubMedGoogle Scholar
  73. 73.
    Chancellor MB, Gajewski J, Ackman CF, Appell RA, Bennett J, Binard J, et al. Long-term follow up of the North American multicenter UroLume trial for the treatment of external detrusor- sphincter dyssynergia. J Urol. 1999;161:1545–50.CrossRefPubMedGoogle Scholar
  74. 74.
    Ninkovic M, Stenzl A, Schwabegger A, Bartsch G, Prosser R, Ninkovic M. Free neurovascular transfer of latissimus dorsi muscle for the treatment of bladder acontractility: II. Clinical results. J Urol. 2003;169:1379–83.CrossRefPubMedGoogle Scholar
  75. 75.
    Gundeti MS, Acharya SS, Zagaja GP, Shalhav AL. Paediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique. BJU Int. 2011;107:962–9.CrossRefPubMedGoogle Scholar
  76. 76.
    Ehrlich RM, Gershman A. Laparoscopic seromyotomy (auto-augmentation) for non-neurogenic neurogenic bladder in a child: initial case report. Urology. 1993;42:175–8.CrossRefPubMedGoogle Scholar
  77. 77.
    Mollard P, Gauriau L, Bonnet JP, Mure PY. Continent cystostomy (Mitrofanoff’s procedure) for neurogenic bladder in children and adolescent (56 cases: long-term results). Eur J Pediatr Surg. 1997;7:34–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Riyad Taher Al-Mousa
    • 1
  • Hashim Hashim
    • 2
  1. 1.Department of UrologyKing Fahad Specialist HospitalDammamSaudi Arabia
  2. 2.Bristol Urological InstituteSouthmead HospitalBristolUK

Personalised recommendations