Neurogenic Bladder: Past, Present, and Future

Abstract

Summary: The foundation of the management of neuragenie bladder can be attributed to a pioneer in spinal cord injury medicine. Dr. Donald Munro, a neurosurgeon, who also had experience in urologic surgery, established the firstSpinal Cord lnjury Service of 1 0 beds in the Boston Cityhospital in the 1 930s. He later became adviser to the US Army and the Veterans Administration (VA). On his recommendation, paraplegic centers were created in US army hospitals and later in the VA hospitals from 1 943 to 1945. This article reviews the evolution of the management of neuragenie bladder in patients with spinal cord injuries from the past century to the present. The role of urodynamics in defining neurologic lesions is critical to the appropriate management of the voiding dysfunction. Key advances, such as the diagnosis of detrusor sphincter dyssynergia (DSD), recognition of its association with autonomic dysreflexia, and its definitive management, have been emphasized. The role of transrectallinear array sonography using a rectal probe was found useful for defining bladder outlet dysfunction du ring urodynamics. lt also helped to recognize secondary bladder neck obstruction and diagnose false passages in the urethra. Clean technique intermittent catheterization (IC) was evaluated and recommended. ln about 28'7'o patients with DSD that led to secondary bladder neck obstruction, a consequence of IC was reported. Transurethrallaser sphincterotomy (TURS) was first reported by mein 1 991, and later, durable 7 -yearfollow-up results were reported in 78'7'o of the first 99 patients. We reported a surgical technique to lengthen the penis. We also reported the long-term success with semirigid implants in 92'7'o of patients with SCI. This technique helped maintain external condom drainage on a small phallus and improved the sex life of patients, as weil as their quality of life. The author's pertinent areas of interest in the past one-half century were aimed at recognizing specific urologic problems associated with neurologic impairment. Management was aimed at preventive care, early recognition, and timely management to reduce secondary complications and enhance quality of life.