Neurogenic detrusor overactivity: an update on management options

Neurogenic detrusor overactivity (NDO) affects a variety of patients with storage and voiding dysfunction including those with multiple sclerosis, spinal cord injuries, Parkinson's disease, cerebral palsy, and myelomeningocele, and includes symptoms of urinary frequency, urgency, and incontinence. Primary treatment goals are 1) preventing renal injury, and 2) improving quality of life. First-line therapies include behavioral and anticholinergic agents, with onabotulinum toxin-A as the only FDA- approved second-line therapy, and non-FDA approved second-line therapies including neuromodulation, and intravesical vanilloids. Surgical intervention is reserved for those at risk for upper-tract deterioration and with persistent incontinence. In select individuals an indwelling catheter may be necessary.