ABSTRACT
Conservative treatment remains the cornerstone for urologic management of the neurologically impaired patient. The principal goals of bladder management in individuals with neurogenic lower urinary tract dysfunction (NLUTD) are to preserve kidney function, achieve urinary continence, minimize urologic complications, and improve quality of life. The approach to treatment of the NLUTD should address both voiding and storage dysfunction. In this chapter, the authors present an abridged overview of the available techniques applied in conservative treatment, including behavioral therapy, physiotherapy, and catheterization. Triggering the bladder reflex achieves voiding through a nonphysiologic mechanism that elicits a reflex detrusor contraction through activation of C-fibers. The most frequently applied maneuver includes suprapubic tapping, an average of seven to eight percussions every 3 seconds until voiding starts. It is essential to perform an early urodynamic study before starting triggered voiding in order to avoid high-pressure development due to detrusor sphincter dyssynergia.
