ABSTRACT
The bladder outlet in patients with neurogenic voiding dysfunction is subject to two main abnormalities: outlet underactivity, leading to urine leakage during increases in intra-abdominal pressure and non-relaxing urethral sphincter, resulting in reduced urine flow during voiding. This chapter focuses on the various treatment options currently employed to treat bladder outlet pathology in the adult neurogenic bladder population. The first use of an injectable substance to treat urinary incontinence dates back to 1938 when Murless instilled sodium murrhate into the anterior vaginal wall. The role of injectable agents in the treatment of urinary incontinence in the neurogenic bladder population remains hard to define. The use of bulking agents to treat incontinence has several advantages including minimal invasiveness, ease to learn, and low morbidity. The fascial sling and the artificial urethral sphincter are the two most commonly employed surgical treatments for patients with urinary incontinence secondary to neurogenic outlet incompetence.
