Neurogenic Bladder with Stress Urinary Incontinence: Surgical Management After Conservative Measures
Patients with neurogenic lower urinary tract dysfunction (NLUTD) who develop stress urinary incontinence represent a distinct clinical population requiring careful assessment before surgical intervention. Patient selection centres on the adequacy of bladder storage prior to addressing the outlet.
This protocol applies to NLUTD patients presenting with stress urinary incontinence. It is important to note that urethral bulking agents are an option in this population, although efficacy is modest and cure is rare — outcomes must be discussed with patients prior to any intervention.
For patients with acceptable bladder storage parameters, surgical outlet procedures — including sling techniques or, in selected cases, an implantable continence device — form the basis of management. The full protocol specifies patient-selection criteria, procedural preferences, and sequencing.
- Clinicians may offer urethral bulking agents to NLUTD patients with stress urinary incontinence but must counsel them that efficacy is modest and cure is rare.
- Clinicians should offer slings to select NLUTD patients with stress urinary incontinence and acceptable bladder storage parameters.
- Clinicians may offer artificial urinary sphincter to select NLUTD patients with stress urinary incontinence and acceptable bladder storage parameters.