Evaluation and Management of Neurogenic Bladder: What Is New in China?

International Journal of Molecular Sciences, 2015 · DOI: 10.3390/ijms160818580 · Published: August 10, 2015

Simple Explanation

Neurogenic bladder (NB) or neurogenic lower urinary tract dysfunction (NLUTD) is a dysfunction of the urinary bladder and urethra due to disease of the central nervous system or peripheral nerves. There are two major types of bladder control problems associated with NB/NLUTD: the bladder becomes either overactive or underactive depending on the nature, level, and extent of nerve damage. Current methods used to treat NB include early neuroprotection actions and special measures focusing on the LUT, including medications, botulinum toxin A (BTX-A) injection, neuromodulation, and surgical procedures.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
Resting-state functional MRI (rs-fMRI) can be used to study the mutual association between the bladder and the brain.
2
Lantox injection into the detrusor muscle significantly reduces urinary tract infections in patients with SCI, potentially related to decreased detrusor pressure.
3
Percutaneous tibial nerve stimulation (PTNS) using adhesive skin-surface electrodes placed on the ankle is effective in treating NDO in 50 patients with spinal cord injuries.

Research Summary

The evaluation and management of NB includes traditional principles and new technologic progress. There are several promising new treatments for NB, although some treatments are still at the animal experimental stage. The overall focus of these approaches is on restorative therapy, while avoiding destructive surgery, aimed at promoting nerve recovery and protecting UUT function.

Practical Implications

Improved UUTD Grading

The new UUTD grading system based on MRU provides clinicians with a more objective, intuitive, and understandable method for UUTD grading.

Lantox as an Alternative

Lantox, a Chinese BTX-A, achieves similar efficacy, safety, and tolerability profiles to Botox at the same doses, with the advantage of being one-third of the cost.

NuStim Development

The development of NuStim, an injectable and wireless mini-stimulator, offers a less invasive alternative for SUI treatment with fewer post-operative and long-term complications.

Study Limitations

1
Limited data on the long-term effects of tissue-engineered bladder augmentation.
2
Many new treatments are still at the animal experimental stage.
3
Clinical experience with β3-Adrenergic Receptor Agonists in neuro-urologic patients is limited.

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