ABSTRACT
Patients with neurogenic bladder suffer from neurogenic detrusor overactivity (NDO), which may be combined with detrusor sphincter dyssynergia (DSD). Both conditions cause high intravesical pressure and can lead to upper urinary tract damage. Treatment for both DSD and NDO can include pharmacologic therapy, catheterization, and surgery. Currently available oral pharmacologic treatments are often insufficient or not well tolerated. This chapter discusses some prominent mechanisms utilized to disrupt the micturition reflex by direct application to the bladder. Two classes of agents i.e., urologics and botulinum toxin A are available commercially, whereas one class, while clinically promising, remains investigational in nature. One of the major factors why patients discontinue intravesical oxybutynin is the practical inconvenience of making fresh solution at each time of instillation. Thus, some have advocated making larger quantities and storing the solutions over time.
