Treatment of Neurogenic Voiding Dysfunction: An Update

Abstract

The neurophysiology of volitional voiding is a poorly understood and constantly evolving field. Some of the most difficult clinical problems in urology arise from structural or neural deviations from this process. These may occur as a result of traumatic injury, congenital defect, or neurological disease. Neurogenic voiding dysfunction is a frequently encountered disorder with multiple etiologies and nonstandardized care. A pervasive complaint in neurogenic voiding dysfunction is detrusor overactivity and resultant urinary incontinence. However, the results of "ideal" initial therapy-catheterization with or without anticholinergicshave been far from satisfactory. This review attempts to go beyond perfunctory measures to explore recent data on anticholinergic therapies, long-term data on botulinum A toxin injections, and applications of neuromodulation.