The Management of Urine Storage Dysfunction in the Neurological Patient

Abstract

To highlight the current aspects and developments in the management of neurogenic urine storage dysfunction and to sensitize urologists for this interdisciplinary and important topic. Neurogenic lower urinary tract dysfunction affects a large proportion of patients with chronic neurological diseases or lesions such as multiple sclerosis, Parkinson's disease, stroke, spina bifida, and spinal cord injury. Such a dysfunction is not only highly bothersome and devastating for the quality of life but also poses a significant risk for health. Particularly, detrusor overactivity and detrusor-sphincterdyssynergia are frequent pathological patterns in neurogenic lower urinary tract dysfunction that are associated with sequelae such as recurrent urinary tract infections and renal impairment. The current cornerstones of treatment for urine storage dysfunction in neurological patients such as intermittent self-catheterization, antimuscarinic drugs, botulinum neurotoxin A intradetrusor injections, augmentation cystoplasty, urinary diversion, and artificial urinary sphincter have significantly contributed to improvements in QoL, health, and survival of neurological patients affected by neurogenic lower urinary tract dysfunction. However, these treatments have not advanced much recently. Moreover, the level of evidence of many therapy options specifically regarding their application in neurological patients is quite low and the main and auxiliary mechanisms of action are often only poorly understood. Despite former accomplishments in Neuro-Urology, more specific evidence for treatments of lower urinary tract dysfunction in neurological patients as well as better knowledge on their mechanisms of action is needed to advance the field and exploit the full treatment potential of available therapies.

Therapeutic Applications of Botulinum Neurotoxin for Autonomic Symptoms in Parkinson’s Disease: An Updated Review

“…Neurogenic overactive bladder manifesting as nocturia is the most reported urinary symptom in PD patients [ 55 , 58 ]. Complications from urinary tract dysfunction include upper urinary tract damage and recurrent urinary tract infections [ 45 ]. Detrusor muscle overactivity and detrusor-sphincter dyssynergy are frequently implicated [ 27 , 44 , 45 ].…”

“…Complications from urinary tract dysfunction include upper urinary tract damage and recurrent urinary tract infections [ 45 ]. Detrusor muscle overactivity and detrusor-sphincter dyssynergy are frequently implicated [ 27 , 44 , 45 ].…”

“…OnabotulinumtoxinA is an effective and approved treatment for neurogenic detrusor overactivity when antimuscarinic medications are not effective or cause side effects [ 41 , 42 , 45 , 54 ]. Intradetrusor injection with up to 360 units of onabotulinumtoxinA may be administered as frequently as every 3 months [ 45 ], although effects may last up to 9 months [ 42 , 55 ]. Transient urinary retention following BoNT injection of the detrusor muscle is a potential complication and may require intermittent or indwelling catheterization [ 41 , 45 , 57 ].…”

“…Intradetrusor injection with up to 360 units of onabotulinumtoxinA may be administered as frequently as every 3 months [ 45 ], although effects may last up to 9 months [ 42 , 55 ]. Transient urinary retention following BoNT injection of the detrusor muscle is a potential complication and may require intermittent or indwelling catheterization [ 41 , 45 , 57 ]. A 2016 phase 3 clinical trial of abobotulinumtoxinA for the treatment of neurogenic detrusor overactivity appears to have been terminated in 2019 due to low patient recruitment [ 69 ].…”

Efficacy of Deep Brain Stimulation on the Improvement of the Bladder Functions in Traumatic Brain Injured Rats

“…Road accidents are a noteworthy source of TBIs and bladder dysfunction is a major and significant outcome of it [ 4 ]. Customary current treatment strategies for bladder dysfunction in neurological patients, such as catheterization, antimuscarinic drugs, intradetrusor injections, and urinary diversion, have significantly contributed to a certain level of improvement in patients’ health and survival [ 5 ]. However, these conventional treatments have not recently been updated.…”