Management of Recurrent Neurogenic Bladder Cystitis

One of the primary goals of management of patients with neurogenic bladder (NB) dysfunction is the prevention of recurrent urinary tract infections (UTI). Inspite of much research in the field, there continue to be gaps in our understanding as to why these patients are vulnerable to recurrent UTIs. UTI rates in the NB population continue to be high and in the absence of clear guidelines on the subject, it is the clinician’s beliefs rather than robust evidence which dictates current prophylactic therapies for UTI prevention. This article reviews the pathophysiology behind recurrent UTI in NB population, the rationale and evidence of traditional preventive therapies, and an update on the upcoming approaches to tackle this difficult problem. Ultimately, an individualized approach, in which the clinician first attempts to identify the contribution of various factors predisposing to UTI in a particular patient, e.g., compromised host defences, impaired washout, catheterization related etc., and then aims to optimize each of those factors is the need of the hour.