Spinal cord injury and bladder dysfunction: new ideas about an old problem.

Area of Science:

• Neuroscience
• Urology
• Regenerative Medicine

Background:

• Lower urinary tract (LUT) control relies on intricate peripheral and central nervous system circuits.
• Spinal cord injury (SCI) disrupts these pathways, leading to bladder dysfunction, initially areflexia, then neurogenic detrusor overactivity (NDO).
• Recent studies highlight urothelial changes as a potential contributor to NDO following SCI.

Purpose of the Study:

• To provide an updated review of LUT dysfunction mechanisms after SCI.
• To discuss current and emerging therapeutic strategies for managing NDO.
• To explore advancements in spinal cord repair for restoring LUT control.

Main Methods:

• Review of recent scientific literature on SCI, LUT control, and NDO.
• Description of the neuroanatomy of LUT control and post-SCI alterations.
• Discussion of therapeutic agents and spinal cord repair mechanisms.

Main Results:

• SCI significantly impairs voluntary bladder control, commonly resulting in NDO.
• Emerging research implicates urothelial alterations in the development of NDO.
• Novel therapeutic options, including vanilloids and botulinum toxin, show promise for NDO treatment.

Conclusions:

• Understanding SCI-induced LUT dysfunction, particularly NDO, is advancing rapidly.
• New therapeutic avenues offer improved management options for NDO.
• Spinal cord repair research holds potential for functional recovery of LUT control.