Neurogenic bladder dysfunction has many different pathogeneses and one drug or therapeutic mechanism would be unlikely to be effective for all causes. The human prostate and the bladder neck contain a dense population of a1AR and stimulation of those receptors results in increased smooth muscle tone and increased closure of the urethra. In-vitro studies have shown that non-selective β-adrenoreceptor (βAR) agonists like isoprenaline have a pronounced inhibitory effect on the human bladder, causing increases in bladder capacity. Studies have found that symptoms of sensory urgency are associated with increased TRPV1 expression in the trigonal mucosa. An orally active TRPV1 antagonist has shown the ability to completely prevent bladder reflex overactivity triggered by capsaicin infusion. The TRPV4 cation channel has been found to mediate stretch-evoked Ca2+ influx and ATP release in primary urothelial cell cultures, suggesting this is a sensor molecule in detecting bladder distension.

This chapter describes the different surgical procedures for managing a neurogenic bladder. The procedures include electrical stimulation, bladder and urethral reconstructive surgery, bladder outlet obstruction management and the treatment of stress urinary incontinence. Electrical stimulation to manage bladder dysfunction in patients with neurological disorders has been used since 1950. Electrical stimulation therapies include intravesical electrostimulation, sacral neuromodulation and sacral anterior root stimulation with selective sacral rhizotomy. Cutaneous continent diversions may be performed in neurological patients, mainly in the young myelomeningocele patient or those with spinal cord injury (SCI) who cannot perform clean intermittent self-catheterization (CISC) via the urethra because of congenital abnormalities, urethral pain, obesity, strictures or poor hand mobility. Finally, the chapter describes the suprapubic catheter (SPC), and sphincter surgery, which relieves bladder outlet obstruction due to external urethral sphincter contraction.