Skip to main content

Advertisement

SpringerLink
Log in

Urinary Tract Infection in the Neurogenic Bladder: an Update of Surgical and Non-surgical Management

  • Neurogenic Bladder (C Powell, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review explores the current literature surrounding non-surgical and surgical management strategies for urinary tract infections (UTIs) in adult patients with neurogenic lower urinary tract dysfunction. UTIs in patients with neurogenic bladders (NB) are recurrent and lifelong contributors to morbidity and mortality. Diagnosis and treatment of UTIs in this patient population are significantly more challenging and require thoughtful clinical decision-making. Topics such as risk factors, diagnosis, nonoperative treatment strategies, and surgical management will be discussed.

Recent Findings

Current recommendations indicate that only symptomatic UTIs require treatment. Nonoperative treatments such as antibiotic therapies, bladder instillations, and coated catheters are typically exercised before proceeding with more invasive surgical management. There are no clear guidelines to recommend when patients should or are required to have surgical intervention.

Summary

Non-surgical management strategies continue to evolve through recent clinical trials. Major surgical intervention is typically considered only after non-surgical options have been exhausted or based on patient and caregiver preference.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. McKibben M, Seed P, Ross S, Borawski K. Urinary tract infection and neurogenic bladder. Urol Clin N Am. 2015;42:527–36. https://doi.org/10.1016/j.ucl.2015.05.006.

    Article  Google Scholar 

  2. Nseyo U, Santiago-Lastra Y. Long-term complications of the neurogenic bladder. Urol Clin N Am. 2017;44:355–66. https://doi.org/10.1016/j.ucl.2017.04.003.

    Article  Google Scholar 

  3. Bergamin P, Kiosoglous A. Non-surgical management of recurrent urinary tract infections in women. Transl Androl Urol. 2017;6:S142–52. https://doi.org/10.21037/tau.2017.06.09.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Vigil HR, Hickling DR. Urinary tract infection in the neurogenic bladder. Transl Androl Urol. 2016;5(1):72–87. https://doi.org/10.3978/j.issn.2223-4683.2016.01.06.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vurture G, Peyronnet B, Palma J, et al. Urodynamic mechanisms underlying overactive bladder symptoms in patients with parkinson disease. Int Neurourol J. 2019;23:211–8. https://doi.org/10.5213/inj.1938086.043.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ragab M, Yang B, Davies M. Urinary tract infections of the neurogenic bladder. Female Urinary Tract Infections in Clinical Practice. 2019;2020:85–97. https://doi.org/10.1007/978-3-030-27909-7_14.

  7. Forster C, Pohl H. Diagnosis of urinary tract infection in the neuropathic bladder: changing the paradigm to include the microbiome. Top Spinal Cord Inj Rehabil. 2019;25:222–7. https://doi.org/10.1310/sci2503-222.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nicolle L, Gupta K, Bradley S, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019. https://doi.org/10.1093/cid/ciy1121.

  9. • Pannek J, Wöllner J. Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions. Res Rep Urol. 2017;9:121–7. https://doi.org/10.2147/RRU.S113610Summarizes current strategies for diagnosis, prophylaxis, and treatment of urinary tract infections in patients with neurogenic bladder.

  10. Linsenmeyer T. Catheter-associated urinary tract infections in persons with neurogenic bladders. J Spinal Cord Med. 2018;41:132–41. https://doi.org/10.1080/10790268.2017.1415419.

    Article  PubMed  PubMed Central  Google Scholar 

  11. •• Dinh A, Hallouin-Bernard M, Davido B, et al. Weekly Sequential antibioprophylaxis for recurrent urinary tract infections among patients with neurogenic bladder: a randomized controlled trial. Clin Infect Dis. 2019. https://doi.org/10.1093/cid/ciz1207This trial assessed the efficacy of weekly oral cyclic antibiotic prophylaxis in preventing recurrent urinary tract infections in patients with neurogenic bladder as a result of spinal cord injury.

  12. Singha P, Locklin J, Handa H. A review of the recent advances in antimicrobial coatings for urinary catheters. Acta Biomater. 2017;50:20–40. https://doi.org/10.1016/j.actbio.

    Article  CAS  PubMed  Google Scholar 

  13. •• Mala R, Annie Aglin A, Ruby Celsia A, Geerthika S, Kiruthika N, VazagaPriya C, et al. Foley catheters functionalised with a synergistic combination of antibiotics and silver nanoparticles resist biofilm formation. IET Nanobiotechnol. 2017;11:612–20. https://doi.org/10.1049/iet-nbt.2016.0148This trial studied the efficacy of urinary catheter impregnation with a combination of antibiotics and silver nanoparticles in preventing biofilm formation.

  14. Huen K, Nik-Ahd F, Chen L, Lerman S, Singer J. Neomycin-polymyxin or gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on clean intermittent catheterization. J Pediatr Urol. 2019;15:178.e1–7. https://doi.org/10.1016/j.jpurol.2018.12.001.

    Article  CAS  Google Scholar 

  15. •• Stalenhoef J, van Nieuwkoop C, Menken P, Bernards S, Elzevier H, van Dissel J. Intravesical gentamicin treatment for recurrent urinary tract infections caused by multidrug resistant bacteria. J Urol. 2019;201:549–55. https://doi.org/10.1016/j.juro.2018.10.004This trial showed the value of intravesical gentamicin instillation in reducing urinary tract infections and antimicrobial resistance for patients with refractory recurrent urinary tract infections.

  16. Mirzaei M, Daneshpajooh A, Farsinezhad A, Jafarian Z, Ebadzadeh MR, Saberi N, et al. The therapeutic effect of intravesical instillation of platelet rich plasma on recurrent bacterial cystitis in women: a randomized clinical trial. Urol J. 2019;6:609–13. https://doi.org/10.22037/uj.v0i0.5239.

    Article  Google Scholar 

  17. • Chernyak S, Salamon C. Intravesical antibiotic administration in the treatment of recurrent urinary tract infections. Female Pelvic Med Reconstr Surg. 2020;26:152–4. https://doi.org/10.1097/SPV.0000000000000810This case series compared the rate of urinary tract infections before and after intravesical antibiotic instillations.

  18. Lucas E. Medical management of neurogenic bladder for children and adults: a review. Top Spinal Cord Inj Rehabil. 2019;25:195–204. https://doi.org/10.1310/sci2503-195.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Toh S, Lee B, Ryan S, et al. Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a randomised controlled trial. Spinal Cord. 2019;57:550–61.

    Article  Google Scholar 

  20. Castle A, Park A, Mitchell A, Bliss D, Gelfand J, De E. Neurogenic bladder: recurrent urinary tract infections—beyond antibiotics. Curr Bladder Dysfunct Rep. 2018;13:191–200. https://doi.org/10.1007/s11884-018-0481-4.

  21. • Husmann D, Viers B. Neurogenic bladder: management of the severely impaired patient with complete urethral destruction: ileovesicostomy, suprapubic tube drainage or urinary diversion—is one treatment modality better than another? Transl Androl Urol. 2020;9:132–41. https://doi.org/10.21037/tau.2019.09.06This study examined surgical complications in the management of patients with neurogenic bladder and complete urethral destruction.

  22. Singh G, Wilkinson J, Thomas D. Supravesical diversion for incontinence: a long-term follow-up. BJU Int. 1997;79:348–53. https://doi.org/10.1046/j.1464-410x.

    Article  CAS  Google Scholar 

  23. Brown E, Osborn D, Mock S, Ni S, Graves A, Milam L, et al. Temporal trends in conduit urinary diversion with concomitant cystectomy for benign indications: a population-based analysis. Urology. 2016;98:70–4.

    Article  Google Scholar 

  24. Al Hussein Al Awamlh B, Lee D, Nguyen D, Green D, Shariat S, Scherr D. Assessment of the quality-of-life and functional outcomes in patients undergoing cystectomy and urinary diversion for the management of radiation-induced refractory benign disease. Urology. 2015;85:394–40. https://doi.org/10.1016/j.urology.2014.08.047.

    Article  PubMed  Google Scholar 

  25. •• Guillot-Tantay C, Chartier-Kastler E, Perrouin-Verbe M, Denys P, Léon P, Phé V. Complications of non-continent cutaneous urinary diversion in adults with spinal cord injury: a retrospective study. Spinal Cord. 2018;56:856–62. https://doi.org/10.1038/s41393-018-0083This study examined long-term complications in adult spinal cord injury patients who underwent urinary diversion.

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Indiana University, 1801 Senate Blvd, Ste 220, Indianapolis, IN, 46202, USA

    Jessica Delgado, Chase Heilbronn & Matthew J Mellon

Authors
  1. Jessica Delgado
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chase Heilbronn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew J Mellon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew J Mellon.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Neurogenic Bladder

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Delgado, J., Heilbronn, C. & Mellon, M.J. Urinary Tract Infection in the Neurogenic Bladder: an Update of Surgical and Non-surgical Management. Curr Bladder Dysfunct Rep 16, 34–40 (2021). https://doi.org/10.1007/s11884-021-00628-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-021-00628-1

Keywords

Search

Navigation