Stress Urinary Incontinence in Women with Neurogenic Lower Urinary Tract Dysfunction

• Published in: Current bladder dysfunction reports Vol. 13; no. 2; pp. 75 - 83
• Main Authors: Dray, Elizabeth V., Cameron, Anne P., Bergman, Rachel
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2018
• Subjects: Geriatrics/Gerontology; Gynecology; Medicine; Medicine & Public Health; Section Editor; Stress Incontinence and Prolapse (S Reynolds; Topical Collection on Stress Incontinence and Prolapse; Urology; Stress incontinence; Neurogenic lower urinary tract dysfunction
• ISSN: 1931-7212; 1931-7220
• DOI: 10.1007/s11884-018-0471-6

Purpose of Review The purpose of this review is to discuss the pathophysiology of neurogenic SUI in the female patient, examine the evidence supporting surgical and non-surgical treatment options, and outline our recommendations for the care of this population. Recent Findings AFPVS appears to be more efficacious than MUS for this group; however, almost all patients will require self-catheterization after surgery. MUS have a higher probability of maintaining spontaneous voiding but also care the risk mesh complications and higher failure rates. Bladder neck AUS placement may also be considered, but most studies show high reoperation rates and have only a few female subjects. In severe refractory cases of SUI or in the setting of urethral erosion, bladder neck closure has been shown to have good continence outcomes. Summary SUI in the setting of neurogenic lower urinary tract dysfunction is often more severe and harder to address than non-neurogenic SUI, due in part to the high rates of ISD in this population. Patients should be screened for other causes of urinary incontinence with UDS prior to any invasive interventions. AFPVS is an appropriate first-line therapy for these patients, particularly in individuals who already perform self-catheterization. Finally, in the setting of moderate to severe urethral erosion, bladder neck closure or urinary diversion should be strongly considered.