This protocol addresses patients with neurogenic detrusor overactivity presenting with urinary urgency, urinary frequency, and urgency urinary incontinence who did not achieve adequate bladder storage outcomes following intradetrusor injection of onabotulinumtoxinA.
The patient has neurogenic detrusor overactivity with storage symptoms: urinary urgency, increased urinary frequency, and urgency urinary incontinence.
Prior treatment with intradetrusor injection of onabotulinumtoxinA did not sufficiently achieve the following targets:
Failure to reach these storage targets is the clinical basis for escalating to the current protocol.
The protocol involves neuromodulatory interventions targeting bladder control. Patient selection is guided by specific clinical eligibility factors — not all patients with neurogenic lower urinary tract dysfunction are candidates. Treatment goals are reduction in urinary urgency, incontinence, and frequency episodes.
The complete regimen — including technique selection, patient eligibility criteria, and procedural details — is available in the full protocol.
Clinicians may offer sacral neuromodulation to select NLUTD patients with urgency, frequency, and/or urgency incontinence.
Clinicians should not offer sacral neuromodulation to NLUTD patients with spinal cord injury or spina bifida.
Clinicians may offer posterior tibial nerve stimulation to select spontaneous voiding NLUTD patients with urgency, frequency, and/or urgency incontinence.
Across all studies, patients demonstrated improvement in daily urgency episodes, weekly incontinence episodes, volume at first sensation, bladder capacity, voided volumes, PVR, urinary frequency, and nocturia.
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