Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real‑life treatment outcome of botulinum toxin A

Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with central nervous system (CNS) lesions, leading to poor bladder control and urinary difficulties. This is often due to a loss of cortical perception of bladder filling and poor coordination of urethral sphincter relaxation. Elderly patients with severe CNS disease often find overactive bladder (OAB) symptoms difficult to relieve with medication, which greatly impacts their quality of life. Botulinum toxin A (BoNT-A) is used for idiopathic and neurogenic OAB related to spinal cord injury or multiple sclerosis. This article reviews the pathophysiology and clinical characteristics of NLUTD in patients with CNS lesions, along with the clinical effects and adverse events of BoNT-A injections. It also provides a flowchart for patient selection and treatment strategy for neurogenic OAB.

• 1
  Patients with CNS-related NLUTD commonly experience uninhibited detrusor overactivity, inadequate detrusor contractility, and dyscoordination of the urethral sphincter during voiding, which can lead to misdiagnosis and inappropriate treatment.
• 2
  Video urodynamic studies (VUDS) of patients with CNS lesions revealed a high prevalence of neurogenic detrusor overactivity (NDO) causing urinary incontinence and a high rate of detrusor underactivity (DU) or functional bladder outlet obstruction (BOO) resulting in difficult urination and large postvoid residual (PVR).
• 3
  Real-life analysis of BoNT-A injections for neurogenic OAB due to CNS lesions showed an overall continence rate of only 28.4%, with dysuria reported in 59.5% of patients, acute urinary retention in 9.5%, and UTI in 14.9%.