Surgical Management of Neurogenic Lower Urinary Tract Dysfunction in Men with Spinal Cord Injury

Following spinal cord injury, many patients can experience neurogenic lower urinary tract dysfunction (nLUTD), which can result in a poorly compliant bladder and/or unpredictable urinary emptying. When medical and intravesical options fail to manage nLUTD, augmentation cystoplasty can be considered to create a urinary reservoir that can store larger volume of urine at low pressures. Continent catheterizable channels can be considered to facilitate ease of catheterization to drain the bladder. Multiple options exist in managing those with intrinsic sphincteric deficiency including bulking agents, bladder neck sling, bulbar urethral sling, artificial urinary sphincter (AUS), and bladder neck closure (BNC). In certain individuals, urinary diversion is a desired treatment option to manage nLUTD. This chapter will explore these various surgeries and their indications, contraindications, surgical approaches and techniques, outcomes, and complications.