Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

Abstract

Management of persistent lower urinary tract dysfunction resulting from severe thoracolumbar spinal cord injury can be challenging. Severe suprasacral spinal cord injury releases the spinal cord segmental micturition reflex from supraspinal modulation and increases nerve growth factor concentration in the bladder wall, lumbosacral spinal cord, and dorsal root ganglion, which subsequently activates hypermechanosensitive C‐fiber bladder wall afferents. Hyperexcitability of bladder afferents and detrusor overactivity can cause urine leaking during the storage phase. During urine voiding, the loss of supraspinal control that normally coordinates detrusor contraction with sphincter relaxation can lead to spinal cord segmental reflex‐mediated simultaneous detrusor and sphincter contractions or detrusor‐sphincter dyssynergia, resulting in inefficient urine voiding and high residual volume. These disease‐associated changes can impact on the quality of life and life expectancy of spinal‐injured animals. Here, we discuss the pathophysiology and management considerations of lower urinary tract dysfunction as the result of severe, acute, suprasacral spinal cord injury. In addition, drawing from experimental, preclinical, and clinical medicine, we introduce some treatment options for neurogenic lower urinary tract dysfunction that are designed to: (1) prevent urine leakage arising because of detrusor overactivity during bladder filling, (2) preserve upper urinary tract integrity and function by reducing intravesical pressure and subsequent vesicoureteral reflux, and (3) prevent urinary tract and systemic complications by treating and preventing urinary tract infections.

Injecting RNA interference lentiviruses targeting the muscarinic 3 receptor gene into the bladder wall inhibits neurogenic detrusor overactivity in rats with spinal cord injury

“…More than two million people worldwide are suffering from spinal cord injury (SCI), approximately 81% of whom experience some degree of neurogenic bladder dysfunction . For example, neurogenic detrusor overactivity (NDO) and detrusor‐sphincter dyssynergia (DSD) are diagnosed in 95% and 68% of patients with SCI, respectively . Characterized by urine leakage during the storage phase, inefficient urine voiding, and high residual volume (RV) during urine voiding, neurogenic bladder dysfunction secondary to supra‐sacral SCI can potentially lead to upper urinary tract damage and substantially impact the health‐related quality of life (QoL) …”

“…1,2 For example, neurogenic detrusor overactivity (NDO) and detrusor-sphincter dyssynergia (DSD) are diagnosed in 95% and 68% of patients with SCI, respectively. 3 Characterized by urine leakage during the storage phase, inefficient urine voiding, and high residual volume (RV) during urine voiding, neurogenic bladder dysfunction secondary to suprasacral SCI can potentially lead to upper urinary tract damage and substantially impact the health-related quality of life (QoL). 3,4 Immunostaining results demonstrated that M 3 receptor was detected in the urothelium, nerve fibers, detrusor, and interstitial cells.…”

“…3 Characterized by urine leakage during the storage phase, inefficient urine voiding, and high residual volume (RV) during urine voiding, neurogenic bladder dysfunction secondary to suprasacral SCI can potentially lead to upper urinary tract damage and substantially impact the health-related quality of life (QoL). 3,4 Immunostaining results demonstrated that M 3 receptor was detected in the urothelium, nerve fibers, detrusor, and interstitial cells. 5 Although the muscarinic 2 (M 2 ) receptor dominates over the M 3 receptor in the detrusor, activation of M 3 receptors on the detrusor muscle by acetylcholine (Ach) is the predominant mechanism involved in the parasympathetic contractile response for urinary bladder voiding.…”

The Frequency and Clinical Implications of Bacteriuria in Chronically Paralyzed Dogs

“…Spinal cord injury (SCI) increases the risk of urinary tract infections (UTIs) in both people and dogs due to impairment of the storage and voiding function of the lower urinary tract. Failure to effectively clear bacteriuria because of infrequent and incomplete urine voiding, as well as introduction of bacteria through indwelling or intermittent catheterization, contribute to development of UTI in these dogs . The overall incidence of UTI is 0.68 episodes per 100 patients per day in chronically paralyzed people .…”

“…The overall incidence of UTI is 0.68 episodes per 100 patients per day in chronically paralyzed people . Appropriate diagnosis and treatment of these infections are important as they increase the risk of pyelonephritis, negatively impact quality of life, and interfere with rehabilitation . Furthermore, UTI is an important cause of septicemia, one of the major contributors to increased mortality in spinal cord‐injured patients .…”