[Conservative-surgical therapy of the neurogenic bladder]

If physical therapy and drugs remain unsuccessful in the treatment of the neurogenic bladder, conservative-operative interventions should be performed prior to urinary diversion. Bladder neck incision, supraselective neurectomy and implantation of a bladder pacemaker in highly selected patients offer a good chance of avoiding diversion. In 64 cases of bladder neck incision, 80% improved or were cured. Experience with the neurectomy in patients with hyperactive detrusor is still limited. The preliminary results, however, proved that this technique should be included in the treatment of neurogenic bladder. 8 of 11 patients in whom a bladder pacemaker was implanted showed voiding following implantation. 7 patients displayed reflex evacuation.