Spinal cord injury and neurogenic lower urinary tract dysfunction: what do we know and where are we going?

One of the well reported but difficult to manage symptoms of spinal cord injury (SCI) is neurogenic lower urinary tract dysfunction (NLUTD). The type of NLUTD is variable based on location and extent of injury. SCI affects more males and NLUTD is especially debilitating for men with incomplete injury. This review summarizes the anatomical basis of NLUTD in SCI and discusses current diagnostic and management strategies that are being utilized clinically. The last two sections address new innovations and emerging discoveries with the goal of increasing scientific interest in improving treatment options for people with SCI. Areas warranting further investigation are pinpointed to address current gaps in knowledge and/or appropriate technology.

Spinal cord injury; Neurogenic lower urinary tract dysfunction; Diagnostics; Neurostimulation; Emerging discoveries

[1] Hou S, Rabchevsky AG. Autonomic consequences of spinal cord injury. Comprehensive Physiology. 2014; 4: 1419–1453.

[2] DeVivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012; 50: 365–372.

[3] Milligan J, Goetz LL, Kennelly MJ. A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dys-function and Urinary Tract Infection after Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation. 2020; 26: 108–115.

[4] Vining RD, Gosselin DM, Thurmond J, Case K, Bruch FR. Inter-disciplinary rehabilitation for a patient with incomplete cervical spinal cord injury and multimorbidity: a case report. Medicine. 2017; 96: e7837.

[5] Skeers P, Battistuzzo CR, Clark JM, Bernard S, Freeman BJC, Batchelor PE. Acute Thoracolumbar Spinal Cord Injury: Rela-tionship of Cord Compression to Neurological Outcome. The Journal of Bone and Joint Surgery. American Volume. 2018; 100: 305–315.

[6] Hamid R, Averbeck MA, Chiang H, Garcia A, Al Mousa RT, Oh S, et al. Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury. World Journal of Urology. 2018; 36: 1517–1527.

[7] Stoffel JT. Detrusor sphincter dyssynergia: a review of physiol-ogy, diagnosis, and treatment strategies. Translational Androl-ogy and Urology. 2016; 5: 127–135.

[8] Adriaansen JJE, van Asbeck FWA, Tepper M, Faber WX, Visser-Meily JMA, de Kort LMO, et al. Bladder-emptying methods, neurogenic lower urinary tract dysfunction and impact on quality of life in people with long-term spinal cord injury. The Journal of Spinal Cord Medicine. 2017; 40: 43–53.

[9] Dorsher PT, McIntosh PM. Neurogenic bladder. Advances in Urology. 2012; 2012: 816274.

[10] Bryk DJ, Zhao LC. Guideline of guidelines: a review of urolog-ical trauma guidelines. BJU International. 2016; 117: 226–234.

[11] Kessler TM, Traini LR, Welk B, Schneider MP, Thavaseelan J, Curt A. Early neurological care of patients with spinal cord in-jury. World Journal of Urology. 2018; 36: 1529–1536.

[12] Sekido N, Igawa Y, Kakizaki H, Kitta T, Sengoku A, Takahashi S, et al. Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord in-jury. International Journal of Urology. 2020; 27: 276–288.

[13] Alsulihem A, Corcos J. Evaluation, treatment, and surveillance of neurogenic detrusor overactivity in spinal cord injury patients. Neuroimmunology and Neuroinflammation. 2019; 6: 13.

[14] Bright E, Cotterill N, Drake M, Abrams P. Developing a vali-dated urinary diary: phase 1. Neurourology and Urodynamics. 2012; 31: 625–633.

[15] Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. American Family Physician. 2008; 77: 643–650.

[16] Liao L, Zhang F, Chen G. New grading system for upper uri-nary tract dilation using magnetic resonance urography in pa-tients with neurogenic bladder. BMC Urology. 2014; 14: 38.

[17] Wyndaele J. The management of neurogenic lower urinary tract dysfunction after spinal cord injury. Nature Reviews. Urology. 2016; 13: 705–714.

[18] Wyndaele JJ. Intermittent catheterization: which is the optimal technique? Spinal Cord. 2002; 40: 432–437.

[19] Burns AS, Rivas DA, Ditunno JF. The Management of Neurogenic Bladder and Sexual Dysfunction after Spinal Cord Injury. Spine. 2001; 26: S129–S136.

[20] Lucas E. Medical Management of Neurogenic Bladder for Children and Adults: a Review. Topics in Spinal Cord Injury Rehabilitation. 2019; 25: 195–204.

[21] Kakizaki H, Ameda K, Kobayashi S, Tanaka H, Shibata T, Koyanagi T. Urodynamic effects of alpha1-blocker tamsulosin on voiding dysfunction in patients with neurogenic bladder. International Journal of Urology. 2003; 10: 576–581.

[22] Chancellor MB, Erhard MJ, Hirsch IH, Stass WE. Prospective evaluation of terazosin for the treatment of autonomic dysreflexia. The Journal of Urology. 1994; 151: 111–113.

[23] Madhuvrata P, Singh M, Hasafa Z, Abdel-Fattah M. Anticholinergic drugs for adult neurogenic detrusor overactivity: a systematic review and meta-analysis. European Urology. 2012; 62: 816–830.

[24] Sager C, Sanmartino M, Burek C, Gomez YR, Vazquez Patiño M, Weller S, et al. Efficacy and safety of Mirabegron as adju-vant treatment in children with refractory neurogenic bladder dysfunction. Journal of Pediatric Urology. 2020; 16: 655.e1– 655. e6.

[25] El Helou E, Labaki C, Chebel R, El Helou J, Abi Tayeh G, Jalkh G, et al. The use of mirabegron in neurogenic bladder: a system-atic review. World Journal of Urology. 2020; 38: 2435–2442.

[26] Thaker H, Zhang S, Diamond DA, Dong M. Beyond botulinum neurotoxin a for chemodenervation of the bladder. Current Opin-ion in Urology. 2021; 31: 140–146.

[27] Martens FMJ, Sievert K. Neurostimulation in neurogenic pa-tients. Current Opinion in Urology. 2020; 30: 507–512.

[28] Sauerwein D. Surgical treatment of spastic bladder paralysis in paraplegic patients. Sacral deafferentation with implantation of a sacral anterior root stimulator. Der Urologe. Ausg. A. 1990; 29: 196–203.

[29] Van Kerrebroeck PE, Koldewijn EL, Rosier PF, Wijkstra H, De-bruyne FM. Results of the treatment of neurogenic bladder dys-function in spinal cord injury by sacral posterior root rhizotomy and anterior sacral root stimulation. The Journal of Urology. 1996; 155: 1378–1381.

[30] Martens FMJ, Heesakkers JPFA. Clinical results of a brindley procedure: sacral anterior root stimulation in combination with a rhizotomy of the dorsal roots. Advances in Urology. 2011; 2011: 709708.

[31] Hohenfellner M, Pannek J, Bötel U, Dahms S, Pfitzenmaier J, Fichtner J, et al. Sacral bladder denervation for treatment of de-trusor hyperreflexia and autonomic dysreflexia. Urology. 2001; 58: 28–32.

[32] Samson G, Cardenas DD. Neurogenic Bladder in Spinal Cord Injury. Physical Medicine and Rehabilitation Clinics of North America. 2007; 18: 255–274.

[33] Wille S, Schumacher P, Paas J, Tenholte D, Eminaga O, Müller U, et al. Catheterless long-term ambulatory urodynamic mea-surement using a novel three-device system. PLoS ONE. 2014; 9: e96280.

[34] Liu L, Zhao K, Chen F, Wu J, Yang Z, Chen M, et al. Testing of a New Portable Device for Dynamic Bladder Pressure Monitor-ing. Lower Urinary Tract Symptoms. 2018; 10: 193–197.

[35] Soebadi MA, Weydts T, Brancato L, Hakim L, Puers R, De Rid-der D. Novel implantable pressure and acceleration sensor for bladder monitoring. International Journal of Urology. 2020; 27: 543–550.

[36] Parittotokkaporn S, Varghese C, O’Grady G, Lawrence A, Svirskis D, O’Carroll SJ. Transcutaneous Electrical Stimulation for Neurogenic Bladder Dysfunction Following Spinal Cord In-jury: Meta-Analysis of Randomized Controlled Trials. Neuro-modulation. 2021; 24: 1237–1246.

[37] de Abreu GE, de Souza LA, da Fonseca MLV, Barbosa TBC, de Mello ERD, Nunes ANB, et al. Parasacral Transcutaneous Electrical Nerve Stimulation for the Treatment of Children and Adolescents with Bladder and Bowel Dysfunction: a Random-ized Clinical Trial. Journal of Urology. 2021; 205: 1785–1791.

[38] Darrow D, Balser D, Netoff TI, Krassioukov A, Phillips A, Parr A, et al. Epidural Spinal Cord Stimulation Facilitates Immedi-ate Restoration of Dormant Motor and Autonomic Supraspinal Pathways after Chronic Neurologically Complete Spinal Cord Injury. Journal of Neurotrauma. 2019; 36: 2325–2336.

[39] Park E, Lee J, Kang M, Cho K, Cho BH, Lee K. Detecting Blad-der Biomarkers for Closed-Loop Neuromodulation: a Techno-logical Review. International Neurourology Journal. 2018; 22: 228–236.

[40] Schäfer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spang-berg A, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourology and Uro-dynamics. 2002; 21: 261–274.

[41] Yu L, Kim BJ, Meng E. Chronically implanted pressure sensors: challenges and state of the field. Sensors. 2014; 14: 20620–20644.

[42] Kirkham APS, Knight SL, Craggs MD, Casey ATM, Shah PJR. Neuromodulation through sacral nerve roots 2 to 4 with a Finetech-Brindley sacral posterior and anterior root stimulator. Spinal Cord. 2002; 40: 272–281.

[43] Yiou R, Audureau E, Loche C, Dussaud M, Lingombet O, Bin-has M. Comprehensive evaluation of embarrassment and pain associated with invasive urodynamics. Neurourology and Uro-dynamics. 2015; 34: 156–160.

[44] Abelson B, Majerus S, Sun D, Gill BC, Versi E, Damaser MS. Ambulatory urodynamic monitoring: state of the art and future directions. Nature Reviews Urology. 2019; 16: 291–301.

[45] Nasrabadi MZ, Tabibi H, Salmani M, Torkashvand M, Zarepour E. A comprehensive survey on non-invasive wearable bladder volume monitoring systems. Medical and Biological Engineer-ing and Computing. 2021; 59: 1373–1402.

[46] Basu AS, Majerus S, Ferry E, Makovey I, Zhu H, Damaser MS. Is submucosal bladder pressure monitoring feasible? Proceed-ings of the Institution of Mechanical Engineers. 2019; 233: 100–113.

[47] Peh WYX, Mogan R, Thow XY, Chua SM, Rusly A, Thakor NV, et al. Novel Neurostimulation of Autonomic Pelvic Nerves Overcomes Bladder-Sphincter Dyssynergia. Frontiers in Neuro-science. 2018; 12: 186.