Save the Bladder: Continent Urinary Diversion as Best Practice for Patients With Refractory Neurogenic Lower Urinary Tract Dysfunction

Introduction: Refractory neurogenic lower urinary tract dysfunction presents an obstinate clinical problem. For patients who fail nonsurgical measures, we advocate for bladder-sparing, continent urinary diversion as the optimal approach to management. Methods: The arguments presented herein were informed by a review of the contemporary literature and our longitudinal institutional experience caring for patients with neurogenic lower urinary tract dysfunction. Results: Bladder-sparing, continent urinary diversion comprises procedures such as bladder augmentation, creation of a continent catheterizable channel, and bladder neck surgeries such as reconstruction, closure, and placement of a compressive sling or artificial sphincter. Such procedures facilitate clean intermittent catheterization, improve continence, and support patients' independent bladder management. These benefits yield quantifiable gains in quality of life, as demonstrated through several contemporary investigations incorporating patient-reported outcomes measures. Moreover, while continent and non-continent diversions are both susceptible to long-term complications, the former can be managed through both surgical and non-surgical means. Conclusions: Continent urinary diversion prioritizes patients' autonomy and quality of life. It should be considered the primary surgical option for patients with refractory neurogenic lower urinary tract dysfunction.