Literature Review: Long-Term Complications of the Neurogenic Bladder

Abstract

This is a review of the most recent literature on the long-term complications of the neurogenic bladder (NGB). It is widely accepted that this condition, when left untreated, has a natural history that has a potential for causing deterioration of renal function over time. Consensus has not been reached regarding what patient profiles are at highest risk for these complications, as well as what surveillance strategies should be adopted. Chronic kidney disease (CKD) may be more prevalent in the NGB population than previously reported in the literature, as creatinine may not accurately reflect true renal function in these patients. Risk factors for upper urinary tract (UUT) deterioration include loss of bladder compliance, repeated bouts of pyelonephritis, and presence indwelling catheterization. Reduced access to urologic care and lack of adequate surveillance are also correlated with increased risk of upper tract complications. The urodynamic evaluation (urodynamic study (UDS)) has an important role in diagnosing the patient’s underlying bladder pathology, but surveillance with UDS has not yet been linked to improved outcomes. Particularly vulnerable are those patients with decreased functional status or those requiring input from a multidisciplinary team. Some patients develop refractory NGB and UUT risk or overt deterioration. Treatment options that can offer benefit include onabotulinum A injections, augmentation cystoplasty with or without sling placement, or urinary diversion.