TAU focused issue on adult management of neurogenic bladder
Within this focused issue of Translation Andrology and Urology (TAU), the treatment of adult neurogenic bladder is explored. My co-editors and I tried to design a focused issue that would explore a full spectrum of topics in adult neurogenic bladder management including: defining and understanding neurogenic bladder physiology, medical management of incontinence, congenital problems, sexual medicine, and advanced surgical techniques. The authors within this issue of TAU represent some of the leaders of the field of neurogenic bladder. I hope you will find their insight into the challenging management of these patients as valuable as I have after reading their manuscripts.
There is probably no field in urology in which so many different physiologies are broadly grouped under a single definition; the diagnosis of neurogenic bladder itself simply relies on the presence of a neurologic disease and varying degrees of urinary symptoms. This leads to a heterogeneous patient population for which there is no single “standard of care”. Because of this heterogeneity, physicians treating these patients require a broad understanding of neurologic conditions, patience, and significant surgical creativity to optimally help patients with neurogenic bladder. There is a multitude of follow-up recommendations and management strategies described throughout the literature, but most are based on historical expert opinion and small, single center observational studies. Another challenge is that the surgical management of these patients’ falls somewhere between community based urology, pediatrics, female, neurourology, and trauma and reconstructive urology. It cannot be emphasized enough that team based care is needed for these patients—all of these sub-specialties play a role in taking care of patients with neurogenic bladder and they all offer unique perspectives from which we can learn.
This is an exciting time in neurogenic bladder research. Through formation of cooperative research groups around the treatment of neurogenic bladder (@GUCongenitalism, www.NBRG.org), we expect the field of neurogenic bladder will be transformed in the best of ways. This transformation will come from dedicated multi-institutional research focused on patient-centered outcomes and leading to evidence-based recommendations at the forefront of neurogenic bladder management.
