Neurogenic Bladder Dysfunction: Surgical Treatment

Surgery in patients with a neurogenic bladder aims at protecting the upper urinary tract while maximizing the patient’s continence status. It is carried out when other modalities, such as medication and minimal invasive procedures, fail to produce optimal results. Factors to consider are the patients’ level and completeness of the neurologic injury, gender, habitus, dexterity and cognitive functions as well as renal function, and bowel availability. Surgery of the neurogenic lower urinary tract (LUT) aims to create a low pressure and continent system when possible, mainly achieved by the use of bowel segments. The incorporation of bowel into the LUT is associated with potential complications that make lifelong surveillance obligatory. Recently, technologic innovations have changed the way LUT reconstruction could be carried out. Robotic surgery is now a legitimate option for LUT reconstruction in both adults and pediatric patients. In the future, regenerative medicine could provide organs that would obviate the need for an intraperitoneal surgery and bowel manipulation with its associated complications. However, currently, this technology has not produced consistent results, and its utilization is not widespread. In this review, we discuss the available surgical treatment options of patients with a neurogenic bladder. This review contains 5 figures, 1 table, and 56 references. Key Words: bladder augmentation, bladder neck closure, neurogenic bladder, neuromodulation, sling, sphincterotomy, surgery, treatment