Diagnosis and Management of Stress Urinary Incontinence in Females With Neurogenic Disease

Abstract

Women with a wide variety of neurological conditions, including multiple sclerosis (MS), Parkinson’s disease (PD), cerebrovascular accidents (CVA), and spinal cord injury (SCI) frequently develop neurovesical dysfunction, commonly resulting in what is often called neurogenic bladder (NGB). The most common manifestations of NGB are urinary urgency, frequency, and urgency urinary incontinence (UUI). However, because many women with NGB conditions lead active lifestyles and are at an age when stress urinary incontinence (SUI) is prevalent, indeed, SUI is not uncommon in affected women. It is also true that, in some conditions, SUI may be a direct result of the neurological insult, for example, patients with low thoracic or lumbar SCI. Thus, deciphering the cause of urinary incontinence in patients with NGB is often complex, yet vital to developing optimal management strategies. This review focuses on the recent literature regarding both the diagnosis and treatment of SUI in women with NGB. In particular, specific strategies that may be essential in evaluating women with NGB and urinary incontinence (UI) will be discussed. Additionally, we will discuss both treatments uniquely applicable to patients with NGB and SUI as well as common treatments that might have unique risks and adaptations in women with NGB. From this review, it is clear that, as standardized practice and technologies continue to grow for management of SUI in patients with comorbid neurological conditions, additional research and analysis may be required to determine the complexities of this unique disease process.