Surgical Options for Patients with Neurogenic Bladder

Abstract

Neurogenic bladder encompasses many conditions that affect the bladder in patients with neurologic disease. Although there is no standard definition for neurogenic bladder, for the intent and purpose of this review, it is defined as any pathologic process affecting the central and/or peripheral nervous systems that results in urine storage or emptying dysfunction. It often presents clinically as varying degrees of urinary incontinence and/or retention but can present with urinary tract infections, urinary tract stones, or upper urinary tract deterioration. It is up to the clinician to identify wherein the problem lies—is it an outlet problem, bladder problem, or both? What is affected: storage, emptying, or both? These factors should be considered together to identify patients who may benefit from surgical intervention. This review focuses on patient evaluation and surgical interventions for adult patients with neurogenic bladder. Surgical interventions for problems with emptying due to detrusor external sphincter dyssynergia include surgical external sphincterotomy, chemical external sphincterotomy, urethral stent, and sphincter dilation. For detrusor underactivity, detrusor myoplasty and neuromodulation are discussed. For neurogenic detrusor overactivity and impaired compliance and capacity, botulinum toxin injection, sacral neuromodulation, and patch enterocystoplasty are discussed. For decreased compliance/capacity, detrusorotomy is also discussed. For combined problems, urinary diversions are also discussed.