Urologic agents for treatment of bladder dysfunction in neurologic disease

Bladder dysfunction, which is commonly associated with neurologic disorders, can present in myriad ways, from complete retention of urine to total urinary incontinence. The multiple options for treating neurogenic bladder dysfunction range from minimally invasive lifestyle changes to major surgical interventions. Interventions may be driven by patient-reported nuisance or by medical necessity, as in the case of impaired compliance with associated upper urinary tract compromise. Pharmacologic treatment has long been the mainstay in the management of bladder dysfunction, particularly for overactive bladder symptoms [1]. While there are many different medications for overactive bladder dysfunction, most are in the category of antimuscarinics. Each medication has a slightly different side effect profile, which may be important in the drug selection process [2]. When these are not tolerated or are ineffective, beta agonists, phosphodiesterase inhibitors, tricyclic antidepressants, and the gamma aminobutyric acid (GABA)-B agonist baclofen can be added or substituted. For difficulty emptying, alpha adrenergic antagonists can be used [3]. Intravesical options are also available for overactive bladder (OAB) symptoms. The most common is botulinum toxin, which works by decreasing the activity of the detrusor smooth muscle, thereby decreasing OAB symptoms [4]. Percutaneous nerve stimulation may also be used [5•].