Not all neurogenic bladders are the same: a proposal for a new neurogenic bladder classification system

Area of Science:

• Neuroscience
• Urology
• Clinical Medicine

Background:

• Neurogenic bladder (NGB) is a complex clinical entity defined by bladder dysfunction secondary to neurologic disorders.
• Current definitions lack specificity regarding the precise bladder defect, natural history, and optimal treatment strategies.
• This heterogeneity poses challenges for effective clinical management and prognosis.

Purpose of the Study:

• To introduce a novel classification system for neurogenic bladder (NGB) to enhance diagnostic precision and treatment guidance.
• To propose a framework that better defines the bladder defect, prognosis, and informs therapeutic decisions.
• To establish a more informative system for describing patients with NGB.

Main Methods:

• Development of a new classification system termed SALE (Stratify by Anatomic Location and Etiology).
• The SALE system categorizes NGB based on seven distinct neurologic defect locations.
• Inclusion of bowel dysfunction and autonomic dysreflexia status in the proposed classification.

Main Results:

• The SALE system provides a structured approach to classifying NGB based on distinct anatomic locations of neurologic deficits.
• It facilitates the reporting of associated bowel dysfunction and autonomic dysreflexia.
• The system is anticipated to improve the description of NGB patients and guide treatment selection.

Conclusions:

• The proposed SALE classification system offers a more precise and clinically relevant method for understanding and managing neurogenic bladder.
• This system is expected to improve treatment selection, follow-up, and long-term prognosis prediction for NGB patients.
• Future integration of biomarkers like urinary NGF and BDNF may further refine prognostic capabilities within this framework.