Treatment of Neurogenic Bladder with Neurogenic Detrusor Overactivity, Urinary Urgency, and Frequency
This protocol covers neurogenic lower urinary tract dysfunction (NLUTD) in patients whose presentation includes neurogenic detrusor overactivity together with urinary urgency, urinary frequency, and urgency urinary incontinence.
Neurogenic detrusor overactivity drives involuntary detrusor contractions, manifesting clinically as urinary urgency, urinary frequency, and urgency urinary incontinence. These storage-phase symptoms define the target population for this first-line protocol.
Management may involve pelvic floor muscle training — particularly relevant for patients with certain underlying neurological diagnoses — and/or oral pharmacotherapy to improve bladder storage. The complete regimen, agent selection, and sequencing are detailed in the full protocol.
The primary objectives are to increase maximum cystometric capacity, decrease detrusor pressure, and reduce urinary incontinence episodes.
References
- Clinicians may offer sacral neuromodulation to select NLUTD patients with urgency, frequency, and/or urgency incontinence.
- Clinicians may recommend pelvic floor muscle training for appropriately selected patients with NLUTD, particularly those with multiple sclerosis or cerebrovascular accident, to improve urinary symptoms and quality of life measures.
- Clinicians may recommend antimuscarinics or beta-3 adrenergic receptor agonists, or a combination of both, to improve bladder storage parameters in NLUTD patients.
- Antimuscarinics reliably increase maximum cystometric capacity (MCC) and voided/catheterized volumes, decrease detrusor pressure, and may improve urgency and incontinence across diverse NLUTD pathologies.