Neurogenic Bladder: Drug Therapy

Therapy goals

  • Improvement of the continent situation
  • Improvement of the quality of life
  • Restoration of the function of the lower urinary tract (which is usually not possible or only partially possible).
  • Protection of the upper urinary tract

Therapy recommendations

The following therapy recommendation depending on the particular disorder:

  • For underlying increased bladder outlet resistance: alpha blockers.
  • For overactive bladder or detrusor-related bladder emptying dysfunction: Anticholinergics or mirabegron (selective agonist of the human β-3-adrenoceptor (β-3-AR) localized in the detrusor).
  • Detrusor overactivity (detrusor overactivity; result of damage to the nervous system from disease, accident, or congenital malformation): Anticholinergics (antimuscarinics) and mirabegron (see above).
  • Detrusor-sphincter dyssynergia (DSD): anticholinergics (antimuscarinics) and mirabegron (see above).
  • Hypocontractile detrusor: anticholinergics or alpha blockers.
  • Nocturia: desmopressin (ADH); also anticholinergics if necessary.
  • For recurrent urinary tract infections, antibiotics should always be used after antibiogram:
  • See also under “Further therapy“.