Current Concepts in Female Neurogenic Voiding Dysfunction

Abstract

Neurogenic lower urinary tract dysfunction (NLUTD) encompasses a wide spectrum of abnormal voiding patterns ranging from detrusor overactivity and urgency to detrusor-external sphincter dyssynergia and urinary retention. NLUTD results from injury to the central or peripheral nervous system or some primary neurological disease that disrupts the normal neurological regulation of the lower urinary tract. Female patients with neurogenic voiding dysfunction deal with special challenges that make management of incontinence and lower urinary tract storage more problematic than in their male counterparts. Over the past 30 years, technological advancements have improved the care of these patients and reduced the morbidity and mortality associated with NLUTD. More recent developments, including intravesical botulinum toxin injection and neuromodulation (not US Food and Drug Administration approved for this indication), have provided further treatment options, resulting in improved quality of life. Still, management of the neurogenic bladder patient can be exceptionally complex, and attentive, specialized care is critical.