Long-term neurogenic lower urinary tract dysfunction: A case of cardiovascular nightmares

Abstract

Context

Individuals with spinal cord injury (SCI) suffering from autonomic dysreflexia (AD) due to neurogenic detrusor overactivity (NDO) can effectively be treated with intradetrusor onabotulinumtoxinA. We present a complex case to highlight the treatment's potential limitations to ameliorate AD and improve lower urinary tract (LUT) function in this population.

Findings

A 46-year old man, who was relying on an indwelling urethral catheter for bladder emptying due to severely impaired hand function following a SCI (C5, AIS B) sustained 30 years ago, underwent intradetrusor onabotulinumtoxinA injections for treatment of refractory NDO and associated AD. Although LUT function slightly improved (i.e. cystometric capacity increased while detrusor pressure was reduced), severe bladder-related AD persisted post-treatment.

Conclusions

This case raises awareness of serious considerations when treating NDO-related AD in individuals with longstanding neurogenic LUT dysfunction and compromised dexterity following SCI. Given the limited improvement in LUT function and persisting bladder-related AD following treatment, urinary diversion as advocated in the wider literature should be considered to protect an individual's urinary tract from further deterioration and thus eliminate bladder-related AD consequences long-term. Early treatment and management of NDO and AD is crucial to minimize complications associated with these two major health risks in this population.

Keywords:

• Autonomic dysreflexia
• Neurogenic detrusor overactivity
• OnabotulinumtoxinA
• Spinal cord injury
• Urodynamic investigation

Acknowledgement

We thank the individual, who provided written informed consent, for participation and publication of this case. We would like to thank Dr. Mark Nigro (Department of Urologic Sciences, UBC, Vancouver, Canada) for the application of onabotulinumtoxinA. Furthermore, we would like to thank Ivy Allard and Tammy Wilder (Vancouver Coastal Health, Vancouver, Canada) for their assistance with the urodynamic assessments.

Disclaimer statements/funding

Contributors None.

Conflicts of interest Authors have no conflict of interests to declare.

Additional information

Funding

M. Walter is a recipient of the Michael Smith Foundation for Health Research Trainee Award in partnership with the Rick Hansen Foundation.