Individualizing Diagnosis and Management of Stress Urinary Incontinence in Neurogenic Lower Urinary Tract Dysfunction

Stress urinary incontinence (SUI), defined as involuntary leakage with effort, exertion, sneezing, or coughing, remains a significant cause of morbidity. While well characterized in the general population, SUI in the setting of neurogenic lower urinary tract dysfunction (NLUTD) poses unique diagnostic and management challenges. This review outlines sex-specific epidemiology, diagnostic strategies, and evolving management approaches for SUI in NLUTD, emphasizing individualized and mechanism-based care.

Incontinence prevalence varies by neurologic diagnosis, with estimates ranging from 23.6% in patients who suffered from stroke to over 50% in patients with spinal cord injury (SCI) and multiple sclerosis (MS). The underlying pathophysiology is highly variable, with neurologic disease influencing detrusor and sphincter function in unpredictable ways. Urodynamic studies have proven especially valuable in this population for distinguishing between sphincteric incompetence and detrusor-driven incontinence, guiding treatment decisions that help safeguard renal function. Noninvasive strategies, including pelvic floor therapy, mechanical devices, and limited pharmacologic options, offer modest benefit and often are constrained by neurologic deficits. Surgical interventions, such as urethral slings, artificial urinary sphincters (AUS), and, in select salvage cases, bladder neck closure, remain central for refractory disease. Recent multicenter studies highlight variable outcomes, with AUS demonstrating durable efficacy, while urethral slings remain appropriate in carefully selected patients with variable anatomy.