Management of Neurogenic Stress Urinary Incontinence: An Updated Review

Managing neurogenic stress urinary incontinence (NSUI) remains a significant challenge. Multiple issues contribute to this, including challenges in accurate diagnosis, coexistence of bladder and bowel dysfunctions, lack of robust scientific evidence supporting various treatment modalities, the diverse preferences of patients, and the need to tailor interventions to an individual's social circumstances. This review aims to update the current alternatives for the surgical management of patients with NSUI.

The scientific landscape in the field of neurogenic stress urinary incontinence (NSUI) remains constrained in terms of both volume and quality of research. In recent years, only a handful of studies have emerged, most of which are retrospective and report on a few patients and relatively short follow-up periods. These studies frequently involve heterogeneous populations and employ varied definitions of success, further complicating the interpretation of results. For women, studies have shown promising results with the use of synthetic midurethral slings and the robotic technique of implanting the artificial urinary sphincter (AUS). Autologous fascial slings continue to be viewed as one of the most appropriate techniques. For men, the robotic technique for AUS implantation at the bladder neck has become the preferred method for AUS implantation in this population. Reasonable results have been shown with male slings. While the AUS has demonstrated efficacy, there is a notable rate of device-related complications. Very limited and poor results have been reported with bulking agents and adjustable continence devices.

Managing NSUI necessitates a multidisciplinary, individualized, patient-tailored approach. Continence rates may decrease over time, and complications must be monitored. Overall, understanding the nuances of surgical options and tailoring treatments to patient needs is paramount to improve quality of life and preserve urinary tract function.