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Objectives: Neurogenic lower urinary tract dysfunction (NLUTD) is one of the major sequelae after spinal cord injury (SCI) and a cause of increased morbidity and mortality in SCI patients. Current treatment strategies for NLUTD include medication, non-invasive conservative management, minimally invasive therapy, and surgical intervention. However, there are no studies regarding non-invasive conservative management that combines pelvic floor muscle (PFM) exercises and electrical stimulation (ES). This study was designed to evaluate the efficacy of individualized bladder rehabilitation programs, which included education on voiding behavior, PFM exercise training combined with electromyography (EMG) biofeedback, and ES (for bladder inhibition or PFM strengthening), in SCI patients with NLUTD. Methods: Individualized bladder rehabilitation programs were provided for 2 months for patients with incomplete SCI at the suprasacral level or cauda equina syndrome. The patients were evaluated using post-voiding residual urine (PVR) amounts and the questionnaires of the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), and Incontinence Impact Questionnaire-7 (IIQ-7). Results: After the individualized bladder rehabilitation programs, the post-voiding residual urine amounts; OABSS, UDI-6, and IIQ-7 scores; and subtotal incontinence score and quality of life (QOL) scores of the IPSS all decreased significantly. These results indicate an improved quality of life and fewer symptoms. However, the changes in the subtotal obstruction score and the total symptom score of the IPSS were not significant. Conclusion: Selected SCI patients with NLUTD could benefit from individualized bladder rehabilitation programs, which include education on voiding behavior, PFM exercises combined with EMG biofeedback, and ES for bladder inhibition or PFM strengthening. Patients who received bladder rehabilitation programs obtained beneficial effects on reducing PVR amounts and QOL scores related to incontinence.

Effect of Individualized Bladder Rehabilitation Program in Patients with Neurogenic Lower Urinary Tract Dysfunction, a Pilot Study