The management of neurogenic lower urinary tract dysfunction due to spinal cord injury is one of the most challenging tasks in rehabilitation. Considerable progress has been made in the management of lower urinary tract dysfunction in patients with spinal cord injury over the past few decades. However, urinary complications remain one of the most serious complications in patients with spinal cord injury. Lower urinary tract dysfunction in patients with spinal cord injury present with a variety of symptoms and signs that require comprehensive evaluation. The management of lower urinary tract dysfunction in patients with spinal cord injury require tailored and individualized treatment approaches. Based on the clinical practice of rehabilitation at home and abroad, this paper expounds the progress of the assessment and rehabilitation of lower urinary tract dysfunction after spinal cord injury, and puts forward some suggestions for the reference of clinical staff.
Injection of botulinum toxin A (BTX-A) into the detrusor muscle and urethral sphincter can block the release of acetylcholine from the presynaptic efferent nerve at the neuromuscular junction, inhibit the contraction of the target muscle, improve bladder pressure and urodynamic parameters, reduce the incidence of urinary tract infection and improve quality of life. Currently, BTX-A has been approved by the Food and Drug Administration for the treatment of neurogenic detrusor overactivity and refractory overactive bladder. A recent clinical trial of BTX-A in the treatment of detrusor-sphincter coordination disorders also reported promising therapeutic effects. This article reviews the BTX-A injection therapy for neurogenic detrusor muscle overactivity and detrusor-sphincter dyssynergia induced by upper motor neuron injury, especially cerebral cortex and suprasacral spinal cord injury.
