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Neurogenic Bladder: Recurrent Urinary Tract Infections—Beyond Antibiotics

  • Inflammatory/Infectious Bladder Disorders (MS Mourad, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Our goal was to identify evidenced-based strategies to prevent and treat patients with neurogenic bladder who suffer from recurrent urinary tract infections. We focused on therapy beyond standard antibiotics to address a multitude of factors implicated in these complex infections.

Recent Findings

Anatomic and functional components specific to neurogenic bladder contribute to the risk of infection and require close clinical monitoring. The host-pathogen interaction is one that allows for colonization of bacteria in the bladder. We recognize that bacteriuria in the neurogenic bladder population does not equate with infection. Local antibiotic treatment and oral supplements are often not adequate to eliminate infection nor prevent recurrent infection due to biofilms. However, novel medical therapies, such as photodynamic therapy, bacterial interference, and infrared laser therapy to augment local immune cells, are promising options to prevent and treat symptomatic infection.

Summary

A combination approach including management of anatomic and functional factors with medical intervention can significantly improve frequency of urinary infection. Further study of non-antibiotic therapeutic strategies is much needed as we recognize the complexity of the urinary biomes and the limitations of antibiotic therapies.

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Authors and Affiliations

  1. Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Alison C. Castle & Jeffrey A. Gelfand

  2. Department of Urology, Massachusetts General Hospital, Boston, MA, 02114, USA

    Albert Park, Alissa J. Mitchell & Elise J. B. De

  3. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, 02129, USA

    Albert Park

  4. School of Nursing, University of Minnesota, Minneapolis, MN, 55455, USA

    Donna Z. Bliss

  5. Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, 02114, USA

    Jeffrey A. Gelfand

  6. Spaulding Rehabilitation Network, Massachusetts General Hospital, Boston, MA, 02114, USA

    Elise J. B. De

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  1. Alison C. Castle
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Correspondence to Alison C. Castle.

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This article is part of the Topical Collection on Inflammatory/Infectious Bladder Disorders

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Castle, A.C., Park, A., Mitchell, A.J. et al. Neurogenic Bladder: Recurrent Urinary Tract Infections—Beyond Antibiotics. Curr Bladder Dysfunct Rep 13, 191–200 (2018). https://doi.org/10.1007/s11884-018-0481-4

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