Intravesical Therapeutics Among People With Spinal Cord Injury and Disease: Time for a Change

Lower urinary tract symptoms (LUTS) are a frequent complaint after spinal cord injury and disease (SCI/D). As such, the majority of people with upper motor neuron SCI/D utilize medications for neurogenic detrusor overactivity (NDO), and overtreatment with systemic antimicrobials is common. Many people with SCI/D utilize urinary catheters for bladder management. These devices offer a conduit for delivery of targeted intravesical therapeutics for both NDO and LUTS (including those due to urinary tract infection [UTI]), which have the potential for greater efficacy due to higher concentration of therapeutics and fewer systemic side effects due to limited permeability of the uroepithelium. Specifically, intravesical therapeutics have the potential to prevent and treat UTI by altering uropathogen's access to the uroepithelium, washout of bacteria, uropathogen adherence, bladder ischemia, and other possible mechanisms of infection. This article presents intravesical therapeutic options for people with neurogenic lower urinary tract dysfunction (NLUTD) due to SCI/D, including bladder flushes and instillates of readily accessible medications and experimental agents (such as live biotherapeutics) in normal saline or sterile water. We propose that the intravesical approach to drug delivery is underutilized for people with NLUTD due to SCI/D and offers a valuable alternative to systemic medications.