Making the Most of Pharmacologic Interventions: Urodynamic Effects of Different Therapies for Neurogenic Lower Urinary Tract Dysfunction Following Spinal Cord Injury.

Management of neurogenic lower urinary tract dysfunction in individuals with spinal cord injury (SCI) involves consideration of patient-specific and bladder-specific factors. Although individuals with SCI prioritize treatment of their symptoms, providers should pay equal, if not more, attention to addressing urodynamic (UDS) parameters such as neurogenic detrusor overactivity (NDO) and impaired compliance due to the associated risk for upper tract deterioration. Anticholinergics, β-3 agonists, and onabotulinumtoxin A (BTX-A) are guideline-supported pharmacotherapies. Though each therapy variably improves NDO, changes in compliance are not well demonstrated. PATIENT SUMMARY: In this review, we examine the efficacy of different classes of pharmacotherapy for improving UDS storage parameters in individuals with SCI. We found that β-3 agonists, particularly vibegron, and anticholinergics make meaningful changes in overactive bladder on UDS, although β-3 agonists may be better tolerated. BTX-A is highly effective even when oral options fail.