Safely Avoiding Surgery in Adult Neurogenic Bladder

Purpose: To evaluate the literature regarding non-surgical management of adult patients with high-pressure neurogenic bladder. Recent Findings: Established therapies that facilitate bladder storage and emptying include anticholinergic medications, intradetrusor onabotulinum toxin injection, and intermittent catheterization. Application of these strategies to patients with elevated detrusor leak point pressures has shown improvement in bladder compliance and preservation of renal function. New interventions in the algorithm of management of patients with poor bladder compliance, such as beta-3 agonists and sacral neuromodulation to facilitate bladder storage the use of alpha antagonists and intraurethral onabotulinum toxin to facilitate bladder emptying are developing. Summary: A multimodal approach to adult patients with high-pressure neurogenic bladder which includes intermittent catheterization, pharmacologic therapy, and intravesical onabotulinumtoxin injection has been associated with improved bladder compliance and preservation of renal function. Augmentation cystoplasty may be reserved for refractory cases. Data is emerging regarding new interventions that can facilitate bladder storage and emptying.