Medical Treatment of Neurogenic Voiding Dysfunction

Abstract

The medical management of neurogenic voiding dysfunction is pain on the neck for urological physician. Most of the patients with neurogenic voiding dysfunction suffered from voiding difficulty, urinary incontinence, and subsequent urinary tract infection, vesico-ureteral reflux, hydroureter, hydronephrosis, impaired renal function, and renal failure. Increase of intravesical pressure would be the cause of vesico-ureteral reflux, hydronephrosis, and inpaired renal function. The principal causes of urinary incontinence in patients with neurogenic bladder are detrusor hyperreflexia (DH) and/or incompetence of urethral closing function. Thus, to improve urinary incontinence the treatment should aim at decreasing detrusor activity, increasing bladder capacity and/or increasing bladder outlet resistance. Pharmacologic therapy has been particularly helpful in patients with relatively mild degrees of neurogenic bladder dysfunction. Patients with more profound neurogenic bladder disturbances may require pharmacologic treatment to augment other forms of management such as intermittent catheterization. The two most commonly used classes of agents are anticholinergics and alpha-adrenergic blockers (Table 1). Intravesical pharmacological therapy will be discussed in the following chapter.