Central Nervous Stimulation for Neurogenic Lower Urinary Tract Dysfunction: Current Application and Emergent Therapies

Purpose of Review: Neurogenic lower urinary tract dysfunction (NLUTD) occurs when control of the bladder, bladder neck, and/or its sphincters is impaired by a neurologic disorder. While neuromodulation is commonly utilized in the treatment of non-neurogenic lower urinary tract symptoms, its use in the management of NLUTD remains largely investigational. This review examines evidences in neuromodulation of the central nervous system as an emerging therapy for NLUTD. Recent Findings: Neuromodulation of the brain and the spinal cord with both invasive and non-invasive modalities can improve subjective symptoms and objective voiding parameters in human patients and animal subjects with NLUTD. There is growing understanding of the neural circuity involved in bladder function, allowing for more targeted neuromodulation. In addition, depending on the stimulation parameters, neuronal activity can either be promoted or inhibited. Summary: Data from small human trials and animal subjects show that neuromodulation of the brain and spinal cord can be an effective treatment for NLUTD. Prospective, sham-controlled studies are needed before adoption of these treatment modalities into clinical use.