Non-invasive conservative treatment

Assisted bladder emptying

Incomplete bladder emptying is a serious risk for urinary tract infection, high pressure inside the bladder (with kidney damage), and incontinence. Methods to improve urination are usually necessary. Methods can be performed outside the body (non-invasive), by putting a device inside the body (invasive), or using drug therapy (pharmacological). An approach should be chosen with your doctor after careful and complete urological assessment.

Bladder expression (Credé manoeuvre) and urinating by abdominal straining

These manoeuvres can help empty the bladder but are rarely recommended. Pressure inside the bladder may rise over acceptable limits and impair kidney function over time (Figure 3). Only in very specific cases may your urologist suggest these techniques. The same applies to triggered reflex voiding, which is possible in some patients—for instance, by repeated light taps on a specific body location—but only following medical advice.

External appliances

These devices are designed to catch urine that leaks during incontinence. Pads and diapers are the most well-known external appliances. For men, a condom catheter with a urine collection device is a practical alternative. Penile clamps should only be used in selected patients and after full medical evaluation.

Neurourological rehabilitation

A variety of techniques are available for rehabilitation of neurourological problems and can be performed in the doctor’s office. Treatments that have shown some positive results for specific neurourological problems include:

  • Electrical stimulation of specific nerves
  • Pelvic floor muscle training
  • Biofeedback

Ask your urologist which methods are available and recommended in your situation.

Drug treatment

No one optimal medical therapy is available for neurourological symptoms. Medications are often used in combination (one drug or more) with other techniques, such as intermittent detrusor. Treatments are tailored to the patient.

Drugs for storage symptoms

Antimuscarinic drugs are used in neurourological patients:

  • to treat overactive bladder (see also patient information on overactive bladder)
  • to increase bladder capacity
  • to reduce urinary incontinence caused by bladder overactivity

These medications have some side effects, such as dry mouth, then can be reduced by lowering the dose or by taking the drug a different way (for instance, through the skin).

Some antimuscarinic drugs are oxybutynin, trospium, tolterodine, propiverine, darifenacin, and solifenacin.

A new category of medications called beta-3 adrenergic receptor agonists was recently introduced. Their use in neurourological patients is currently being studied.

Drugs for voiding symptoms

Drugs called alpha blockers seem to improve urination and may reduce the risk of sudden high blood pressure (autonomic dysreflexia). Some alpha blockers are tamsulosin and naftopidil.

Drug therapy is not recommended if your bladder does not contract enough (underactive bladder) or if your sphincter is not strong enough (severe stress urinary incontinence).

Fig.1: Bladder expression and abdominal straining should be avoided unless proven necessary because high pressure inside the bladder and impairment of kidney function may result.
Fig.1: Bladder expression and abdominal straining should be avoided unless proven necessary because high pressure inside the bladder and impairment of kidney function may result.