The Management of Urine Storage Dysfunction in the Neurological Patient

To highlight the current aspects and developments in the management of neurogenic urine storage dysfunction and to sensitize urologists for this interdisciplinary and important topic. Neurogenic lower urinary tract dysfunction affects a large proportion of patients with chronic neurological diseases or lesions such as multiple sclerosis, Parkinson’s disease, stroke, spina bifida, and spinal cord injury. Such a dysfunction is not only highly bothersome and devastating for the quality of life but also poses a significant risk for health. Particularly, detrusor overactivity and detrusor-sphincter-dyssynergia are frequent pathological patterns in neurogenic lower urinary tract dysfunction that are associated with sequelae such as recurrent urinary tract infections and renal impairment. The current cornerstones of treatment for urine storage dysfunction in neurological patients such as intermittent self-catheterization, antimuscarinic drugs, botulinum neurotoxin A intradetrusor injections, augmentation cystoplasty, urinary diversion, and artificial urinary sphincter have significantly contributed to improvements in QoL, health, and survival of neurological patients affected by neurogenic lower urinary tract dysfunction. However, these treatments have not advanced much recently. Moreover, the level of evidence of many therapy options specifically regarding their application in neurological patients is quite low and the main and auxiliary mechanisms of action are often only poorly understood. Despite former accomplishments in Neuro-Urology, more specific evidence for treatments of lower urinary tract dysfunction in neurological patients as well as better knowledge on their mechanisms of action is needed to advance the field and exploit the full treatment potential of available therapies.