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Page 2 of 13 Alsulihem et al. Neuroimmunol Neuroinflammation 2019;6:13 I http://dx.doi.org/10.20517/2347-8659.2019.007

[4]
Figure 1. Lower urinary tract innervation (adopted from Aldousari et al. )

The effect of SCI on the lower urinary tract is variable and depends on the level and extent of the injury.
Neurogenic detrusor overactivity (NDO) is a common urodynamic finding, reported to be present in
[3]
up to 95% of supra-sacral SCI . The ultimate goal of the management of neurogenic lower urinary tract
dysfunction is to avoid morbidity and mortality secondary to renal failure and/or infections and to improve
quality of life by controlling incontinence. The goal of this review article is to present an up-to-date
pathway of the evaluation, treatment, and surveillance of NDO in SCI patients.

CLASSIFICATION OF NEUROGENIC LOWER URINARY TRACT DYSFUNCTION IN PATIENTS
WITH SCI
The lower urinary tract is innervated by the hypogastric nerve, the pelvic nerve, and the pudendal nerve.
The hypogastric nerve carries sympathetic innervation from spinal level T10-L1, while pelvic and pudendal
nerves carry parasympathetic (pelvic), and motor and sensory innervation (pudendal) from the sacral
[4]
spinal cord (S2-S4) [Figure 1] . Lower urinary tract dysfunction often follows certain patterns, based on
the level of the injury, which can be classified into supra-pontine, infra-pontine supra-sacral, sacral, or
[5]
infra-sacral . The supra-sacral injury often results in NDO and infra-pontine supra-sacral lesions often
[5]
result in detrusor-sphincter dyssynergia [Figure 2] . SCI at the vertebral level of T11 may cause sacral
nerve damage which may cause underactive detrusor. Injury at the vertebral level of T7 may result in NDO.
[6]
Injury in vertebral levels between T8 and T10 can generate either hypotonic or overactive detrusor . It
should be noted that those patterns do not happen in all patients, and further urological evaluation is
mandatory to all patients to determine the exact neurogenic lower urinary tract dysfunction regardless of
the level of SCI.