Table 13.

Managing the urinary dysfunction following transverse myelitis

	Treatment Options	Comments
Detrusor hyperreflexia (failure to store)	•Anticholinergic agents (eg, trospium, fesoterodine, oxybutynin, tolterodine) •Selective M2- and M3-antimuscarinics (darifenacin and solifenacin)	Common side effects include dry mouth and constipation. Contraindicated in patients with angle-closure glaucoma and mechanical bladder outlet obstruction. Nonselective agents should be used cautiously, if at all, in patients with cognitive dysfunction.
	•Intravesical atropine, oxybutinin, capsaicin, or resiniferatoxin •Detrusor muscle botulinum toxin A injection •Suprapubic vibration ("Queen Square bladder stimulator")
Detrusor-sphincter dyssynergia	•Alpha-1 adrenergic antagonists (eg, tamsulosin) •Clean intermittent catheterization (CIC) •Suprapubic vibration ("Queen Square bladder stimulator") •Neuromodulation (InterStim) •Intrasphincteric botulinum toxin •Indwelling Foley catheter •Suprapubic catheter	Alpha antagonists may cause hypotension, tachycardia, and bladder incontinence, particularly in those patients with coincident bladder spasms. CIC should be considered if postvoid residual volume exceeds 100 mL. Patients with sacral nerve stimulators cannot undergo MRIs. Indwelling Foley catheters are contraindicated in females.
Frequent urinary tract infections	Appropriate antibiotics Prophylactic antibiotic therapy Cranberry preparations Vitamin C supplementation	Cystoscopic evaluation may be needed to look for bladder trabeculations that serve as a nidus for infections.
Painful bladder spasms	Pharmacotherapy Timed voiding Neuromodulation	Pharmacotherapy: baclofen, benzodiazepines, hyoscine butylbromide, gabapentin and cannabinoids.
Nocturia	Behavioral measures Pelvic floor exercises Imipramine Desmopressin (DDAVP) Bladder rehabilitation	Avoid alcoholic and caffeinated beverages after 5 pm, to limit fluid intake in the evening, to avoid any fluids 2 h before bedtime and to void before going to bed.

Data from Refs.3, 297, 298, 458, 459, 460, 461, 462, 463, 464, 465