Clinical guidelines of patient-centered bladder management of neurogenic lower urinary tract dysfunction due to chronic spinal cord injury - Part 2: Conservative and minimally invasive treatment

Yao Lin Kao, Jian Ting Chen, Sung Lang Chen, I. Hung Shao, Chung Cheng Wang, I. Ni Chiang, Yu Chao Hsu, Kau Han Lee, Wei Chia Lee, Ting Chun Yeh, Yuh Chen Kuo, Bing Juin Chiang, Chun Hou Liao, Po Cheng Chen, En Meng, Yung Chin Lee, Hann Chorng Kuo

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)

Abstract

Bladder management of chronic spinal cord injured (SCI) patients usually starts with conservative treatment or minimally invasive procedures. This article reports the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among patients with chronic SCI in Taiwan. We evaluated the role of clean intermittent catheterization (CIC), cystostomy, medical treatment, and minimally invasive therapy for treating urinary incontinence and voiding dysfunction in patients with chronic SCI. The bladder management for chronic SCI patients should be individualized. A balance between upper urinary tract protection and life quality improvement should be considered. Hand dexterity, abdominal muscle power, bladder sensation, and degree of urethral sphincter dyssynergia might affect the improvement of voiding efficiency and NLUTD. Intradetrusor Botulinum Toxin Type A (BoNT-A) injection has been proven to effectively treat neurogenic detrusor overactivity in SCI patients. However, CIC is still required in some patients after treatment. The urethral sphincter BoNT-ABoNT-A injection can effectively relax the dyssynergic sphincter; however, exacerbation of urinary incontinence usually limits its application in SCI patients. Repeat BoNT-ABoNT-A injection is necessary to maintain the therapeutic efficacy; therefore, some SCI patients might discontinue the treatment and convert to a permanent bladder management by surgical intervention. Identification of high-risk SCI patients is important to prevent renal functional deterioration in those with chronic SCI-NLUTD. Avoiding renal function deterioration and improving the quality of life of SCI patients with NLUTD are the most important aspects of treatment. Annual active surveillance of bladder and renal function is necessary.

Original languageEnglish
Pages (from-to)10-17
Number of pages8
JournalUrological Science
Volume34
Issue number1
DOIs
Publication statusPublished - 2023 Jan

All Science Journal Classification (ASJC) codes

  • Urology

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