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Neurogenic lower urinary tract dysfunction in ageing men with spinal cord injury

Nature Reviews Urology (2026)Cite this article

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Abstract

The management of neurogenic lower urinary tract dysfunction in ageing men with spinal cord injury is defined by the compounding interaction between prostate enlargement, neurogenic detrusor overactivity and detrusor-sphincter dyssynergia. The effects of spinal cord injury and an ageing bladder create unique challenges, including a 16–28-fold increased risk of urinary bladder cancer and a high prevalence of catheter-related complications. Importantly, although clean intermittent catheterization is the gold standard for treating lower urinary tract dysfunction, in many elderly patients, functional decline forces a transition to indwelling catheters, necessitating a shift in care strategy. Furthermore, prostate procedures such as transurethral resection of the prostate (TURP) and holmium laser enucleation, which are commonly carried out in older men, carry an increased risk of complications, including autonomic dysreflexia. Integrated, age-stratified guidelines are currently missing. Thus, a proactive, patient-centred framework for lifelong urological care is needed and should incorporate frailty assessments, sophisticated diagnostics to disentangle detrusor sphincter dyssynergia from prostate enlargement, and personalized management pathways to preserve renal function and quality of life.

Key points

  • The urological challenges in ageing men with spinal cord injury (SCI) arise from a compounding pathophysiology, where neurogenic detrusor overactivity, detrusor sphincter dyssynergia and prostate enlargement interact, creating a dual pathophysiology of outlet obstruction.

  • Urinary bladder cancer risk is 16–28-fold higher in patients with SCI than in able-bodied individuals; the predominant subtype is squamous cell carcinoma, driven by chronic inflammation from long-term catheter use.

  • Functional decline rather than urological failure drives a necessary transition from clean intermittent catheterization to indwelling catheters in up to 62% of ageing men — a crucial crossroads in management.

  • Prostate interventions require autonomic dysreflexia precautions; outcomes of procedures such as transurethral resection of the prostate are poor if detrusor sphincter dyssynergia is misidentified as the primary cause of obstruction, highlighting the necessity of accurate urodynamic diagnosis with expert interpretation to guide intervention.

  • The timing of SCI (lifelong versus late-onset) substantially influences urological risk profiles and management priorities across the lifespan. A proactive framework for lifelong care, integrating frailty assessments and anticipatory guidance, is crucial to replace reactive, problem-based approaches.

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Fig. 1: Age-related lower urinary tract changes in men with spinal cord injury.
Fig. 2: A proactive clinical framework for the lifelong urological care of ageing men with spinal cord injury.

References

  1. Pattanakuhar, S. et al. Impacts of bladder managements and urinary complications on quality of life: cross-sectional perspectives of persons with spinal cord injury living in Malaysia, Indonesia, and Thailand. Am. J. Phys. Med. Rehabil. 102, 214–221 (2023).

    Article  PubMed  Google Scholar 

  2. Panicker, J. N., Fowler, C. J. & Kessler, T. M. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol. 14, 720–732 (2015). Establishes standardized assessment protocols for neurogenic lower urinary tract dysfunction across neurological disorders.

    Article  PubMed  Google Scholar 

  3. Bott, S. R. J. et al. (eds) in Textbook of Men’s Health and Aging 2nd edn 115–129 (CRC, 2007).

  4. Ginsberg, D. A. et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation. J. Urol. 206, 1097–1105 (2021). Offers consensus recommendations for diagnosis and evaluation of neurogenic lower urinary tract dysfunction, endorsed by major urological associations.

    Article  PubMed  Google Scholar 

  5. Elterman, D. et al. UPDATE — 2022 Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH). Can. Urol. Assoc. J. 16, 245–256 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kavanagh, A. et al. Canadian Urological Association guideline: diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction — executive summary. Can. Urol. Assoc. J. 13, 156–165 (2019).

    PubMed  PubMed Central  Google Scholar 

  7. Weinstein, J. R. & Anderson, S. The aging kidney: physiological changes. Adv. Chronic Kidney Dis. 17, 302–307 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  8. Suskind, A. M. The aging overactive bladder: a review of aging-related changes from the brain to the bladder. Curr. Bladder Dysfunct. Rep. 12, 42–47 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lu, Y. et al. Global incidence and characteristics of spinal cord injury since 2000–2021: a systematic review and meta-analysis. BMC Med. 22, 285 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zadra, A. et al. Life expectancy and long-term survival after traumatic spinal cord injury: a systematic review. Eur. J. Phys. Rehabil. Med. 60, 822–831 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Stoffel, J. T. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies. Transl. Androl. Urol. 5, 127–135 (2016).

    PubMed  PubMed Central  Google Scholar 

  12. Panicker, J. N. Neurogenic bladder: epidemiology, diagnosis, and management. Semin. Neurol. 40, 569–579 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Rabchevsky, A. G., Hou, S. & Rabchevsky, A. G. Autonomic consequences of spinal cord injury. Compr. Physiol. 4, 1419–1453 (2014).

    Article  PubMed  Google Scholar 

  14. Chancellor, M. B., Kaplan, S. A. & Blaivas, J. G. Detrusor-external sphincter dyssynergia. Ciba Found. Symp. 151, 195–206 (1990).

    CAS  PubMed  Google Scholar 

  15. Walter, M. et al. Fesoterodine ameliorates autonomic dysreflexia while improving lower urinary tract function and urinary incontinence-related quality of life in individuals with spinal cord injury: a prospective phase IIa study. J. Neurotrauma 40, 1020–1025 (2023).

    Article  PubMed  Google Scholar 

  16. Sartori, A. M. et al. Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology. Eur. Urol. 85, 543–555 (2024).

    Article  PubMed  Google Scholar 

  17. Walter, M. et al. Protocol for a phase II, open-label exploratory study investigating the efficacy of fesoterodine for treatment of adult patients with spinal cord injury suffering from neurogenic detrusor overactivity for amelioration of autonomic dysreflexia. BMJ Open 8, e024084 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Carlstedt, T. & Havton, L. in Handbook of Clinical Neurology Vol. 109 (eds Verhaagen, J. & McDonald, J. W. III) 337–354 (Elsevier, 2012).

  19. Krassioukov, A. et al. Evaluation and management of autonomic dysreflexia and other autonomic dysfunctions: preventing the highs and lows: management of blood pressure, sweating, and temperature dysfunction. Top. Spinal Cord Inj. Rehabil. 27, 225–290 (2021). Provides critical guidelines for managing autonomic dysreflexia during urological procedures in patients with high-level spinal cord injury.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Khurana, R. K. in Encyclopedia of the Neurological Sciences (eds Aminoff, M. J. & Daroff, R. B.) 345–347 (Academic, 2014).

  21. Christison, K. et al. Intermittent catheterization: the devil is in the details. J. Neurotrauma. 35, 985–989 (2018). Evidence-based analysis supporting intermittent catheterization as the gold standard, while highlighting challenges in ageing spinal cord injury populations.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Miller, T. et al. The microbiological burden of short-term catheter reuse in individuals with spinal cord injury: a prospective study. Biomedicines 11, 1929 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Sun, A. J., Comiter, C. V. & Elliott, C. S. The cost of a catheter: an environmental perspective on single use clean intermittent catheterization. Neurourol. Urodyn 37, 2204–2208 (2018).

    Article  PubMed  Google Scholar 

  24. Groen, J. et al. Summary of European Association of Urology (EAU) guidelines on neuro-urology. Eur. Urol. 69, 324–333 (2016).

    Article  PubMed  Google Scholar 

  25. Miller, T. et al. The temporal burden of preparing catheters for re-use in adults with spinal cord injury: a cross-sectional study. Spinal Cord. Ser. Cases 9, 39 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Ho, C. H. et al. Chronic indwelling urinary catheter increase the risk of bladder cancer, even in patients without spinal cord injury. Medicine 94, e1736 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Taylor, J. A. & Kuchel, G. A. Detrusor underactivity: clinical features and pathogenesis of an underdiagnosed geriatric condition. J. Am. Geriatr. Soc. 54, 1920–1932 (2006).

    Article  PubMed  Google Scholar 

  28. Drake, M. J., Cortina-Borja, M., Savic, G., Charlifue, S. W. & Gardner, B. P. Prospective evaluation of urological effects of aging in chronic spinal cord injury by method of bladder management. Neurourol. Urodyn. 24, 111–116 (2005).

    Article  CAS  PubMed  Google Scholar 

  29. Böthig, R. et al. Urinary bladder cancer as a late sequela of traumatic spinal cord injury. Mil. Med. Res. 8, 29 (2021). Quantifies 16–28-fold increased urinary bladder cancer risk in patients with spinal cord injury compared with able-bodied individuals, with emphasis on squamous cell carcinoma predominance.

    PubMed  PubMed Central  Google Scholar 

  30. Böthig, R. et al. Clinical characteristics of bladder cancer in patients with spinal cord injury: the experience from a single centre. Int. Urol. Nephrol. 49, 983–994 (2017).

    Article  PubMed  Google Scholar 

  31. Yu, E. mi, Belay, S., Li, W. & Aragon-Ching, J. B. Non-urothelial and urothelial variants of bladder cancer. Cancer Treat. Res. Commun. 33, 100661 (2022).

    PubMed  Google Scholar 

  32. Fonda, D. et al. in Incontinence 2nd edn (eds Abrams, P. et al.) 627–694 (Health Publications, 2002).

  33. Lee, C. L. & Kuo, H. C. Pathophysiology of benign prostate enlargement and lower urinary tract symptoms: current concepts. Tzu-Chi Med. J. 29, 79–83 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wyndaele, J. Complications of intermittent catheterization: their prevention and treatment. Spinal Cord 40, 536–541 (2002).

    Article  CAS  PubMed  Google Scholar 

  35. Waller, M., Jörgensen, S. & Lexell, J. Changes over 6 years in secondary healthy conditions and activity limitations in older adults aging with long-term spinal cord injury. PM R 15, 157–167.

  36. Przydacz, M. & Goldman, H. B. Videourodynamics — role, benefits and optimal practice. Nat. Rev. Urol. 22, 130–150 (2025).

    Article  PubMed  Google Scholar 

  37. Groah, S. L. et al. Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury. J. Cardiopulm. Rehabil. Prev. 31, 73–80 (2011).

    Article  PubMed  Google Scholar 

  38. Ye, Z. et al. Global burden of benign prostatic hyperplasia in males aged 60–90 years from 1990 to 2019: results from the global burden of disease study. BMC Urol. 24, 193 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Sim, S. C. Managing the elderly with urinary incontinence and dementia. Int. Arch. Urol. Complic. 3, 027 (2017).

    Google Scholar 

  40. Abdelmoteleb, H., Jefferies, E. R. & Drake, M. J. Assessment and management of male lower urinary tract symptoms (LUTS). Int. J. Surg. 25, 164–171 (2016).

    Article  PubMed  Google Scholar 

  41. Gofrit, O. N. et al. A study of prostate volumes in patients with spinal cord injury. Neurourol. Urodyn. 38, 684–688 (2019).

    Article  PubMed  Google Scholar 

  42. Reynard, J. M., Vass, J., Sullivan, M. E. & Mamas, M. Sphincterotomy and the treatment of detrusor–sphincter dyssynergia: current status, future prospects. Spinal Cord. 41, 1–11 (2003).

    Article  CAS  PubMed  Google Scholar 

  43. Koyanagi, T. Experience with electromyography of the external urethral sphincter in spinal cord injury patients. J. Urol. 127, 272–276 (1982).

    Article  CAS  PubMed  Google Scholar 

  44. Khan, S. J. & Khastgir, J. Assessment of lower urinary tract symptoms. Surgery 34, 333–341 (2016).

    Google Scholar 

  45. Barbonetti, A. et al. Risk of prostate cancer in men with spinal cord injury: a systematic review and meta-analysis. Asian J. Androl. 20, 555–560 (2018).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Abrams, P. et al. Tamsulosin: efficacy and safety in patients with neurogenic lower urinary tract dysfunction due to suprasacral spinal cord injury. J. Urol. 170, 1242–1251 (2003).

    Article  PubMed  Google Scholar 

  47. Sullivan, J. & Abrams, P. Alpha-adrenoceptor antagonists in neurogenic lower urinary tract dysfunction. Urology 53, 21–28 (1999).

    Article  CAS  PubMed  Google Scholar 

  48. Lepor, H. Alpha-blockers for the treatment of benign prostatic hyperplasia. Rev. Urol. 9, 181–190 (2007).

    PubMed  PubMed Central  Google Scholar 

  49. Otzel, D. M. et al. Musculoskeletal and body composition response to high-dose testosterone with finasteride after chronic incomplete spinal cord injury — a randomized, double-blind, and placebo-controlled pilot study. Front. Neurol. 15, 1479264 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  50. Goldenberg, L. et al. The role of 5-alpha reductase inhibitors in prostate pathophysiology: Is there an additional advantage to inhibition of type 1 isoenzyme? Can. Urol. Assoc. J. 3, S109 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  51. Kim, E. H., Brockman, J. A. & Andriole, G. L. The use of 5-alpha reductase inhibitors in the treatment of benign prostatic hyperplasia. Asian J. Urol. 5, 28–32 (2018).

    Article  CAS  PubMed  Google Scholar 

  52. Ito, H. et al. Effects of β3 agonists and anticholinergic drugs on defecation in patients with overactive bladder. In Vivo 36, 1847–1853 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Zhang, H. & Wang, Y. Short-term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: a systematic review and meta-analysis. Biomed. Rep. 23, 1–11 (2025).

    CAS  Google Scholar 

  54. Welk, B. & McArthur, E. Increased risk of dementia among patients with overactive bladder treated with an anticholinergic medication compared to a beta-3 agonist: a population-based cohort study. BJU Int. 126, 183–190 (2020).

    Article  CAS  PubMed  Google Scholar 

  55. Li, K. H. et al. Cumulative anticholinergic exposure and white matter hyperintensity burden in community-dwelling older adults. J. Am. Geriatr. Soc. 73, 1115–1124 (2025).

    Article  PubMed  Google Scholar 

  56. Wielage, R. C. et al. Mirabegron for the treatment of overactive bladder: cost-effectiveness from US commercial health-plan and Medicare advantage perspectives. J. Med. Econ. 19, 1135–1143 (2016).

    Article  PubMed  Google Scholar 

  57. He, W. et al. Efficacy and safety of vibegron compared with mirabegron for overactive bladder: a systematic review and network meta-analysis. Low. Urin. Tract Symptoms 15, 80–88 (2023).

    Article  CAS  PubMed  Google Scholar 

  58. Elkhashab, M. M. et al. Safety and efficacy of beta-3 adrenergic agonists in treating neurogenic lower urinary tract dysfunction: a systematic review and meta-analysis. Investig. Clin. Urol. 65, 217–229 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  59. Sandhu, J. S., Te, A. E. Huhtaniemi, I. & Martini, L. (eds) in Encyclopedia of Endocrine Diseases 341–344 (Academic, 2018).

  60. Noordhoff, T. C., Groen, J., Scheepe, J. R. & Blok, B. F. M. Surgical management of anatomic bladder outlet obstruction in males with neurogenic bladder dysfunction: a systematic review. Eur. Urol. Focus 5, 875–886 (2019).

    Article  PubMed  Google Scholar 

  61. Charalampous, I. et al. Does surgical treatment for benign prostate enlargement (BPE)-related bladder outlet obstruction (BOO) benefit patients with central nervous system diseases? A systematic review. J. Clin. Med. 13, 5846 (2024).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Pires Vaz, A. S. F., Ribeiro, S., Lopes, J. D. & Figueiredo, E. Transurethral resection of the prostate-like syndrome after double-J replacement in a patient with chronic spinal cord injury: case report. J. Endourol. Case Rep. 6, 336 (2020).

    Article  PubMed Central  Google Scholar 

  63. Rempel, L. et al. From toxin to treatment: a narrative review on the use of botulinum toxin for autonomic dysfunction. Toxins 16, 96 (2024).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Linsenmeyer, T. A. Use of botulinum toxin in individuals with neurogenic detrusor overactivity: state of the art review. J. Spinal Cord Med. 36, 402–419 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  65. Chen, C. Y., Liao, C. H. & Kuo, H. C. Therapeutic effects of detrusor botulinum toxin A injection on neurogenic detrusor overactivity in patients with different levels of spinal cord injury and types of detrusor sphincter dyssynergia. Spinal Cord 49, 659–664 (2011).

    Article  PubMed  Google Scholar 

  66. Asafu-Adjei, D. et al. The intravesical injection of highly purified botulinum toxin for the treatment of neurogenic detrusor overactivity. Can. Urol. Assoc. J. 14, E520–E526 (2019).

    Article  Google Scholar 

  67. Kuo, H. C. Therapeutic satisfaction and dissatisfaction in patients with spinal cord lesions and detrusor sphincter dyssynergia who received detrusor botulinum toxin a injection. Urology 72, 1056–1060 (2008).

    Article  PubMed  Google Scholar 

  68. Stading, R. et al. Intradetrusor OnabotulinumtoxinA outcomes for overactive bladder in older adults. Continence 12, 101725 (2024).

    Article  Google Scholar 

  69. De Sèze, M. et al. Botulinum A toxin and detrusor sphincter dyssynergia: a double-blind lidocaine-controlled study in 13 patients with spinal cord disease. Eur. Urol. 42, 56–62 (2002).

    Article  PubMed  Google Scholar 

  70. Chen, C. A pilot study of concomitant injection of botulinum toxin type A in detrusor and external sphincter for treatment of neurogenic bladder dysfunction in six patients with spinal cord injury. Rehabil. Pract. Sci. 45, 89–95 (2017).

    CAS  Google Scholar 

  71. Shackleton, C. et al. Motor and autonomic concomitant health improvements with neuromodulation and exercise (MACHINE) training: a randomised controlled trial in individuals with spinal cord injury. BMJ Open 13, e070544 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  72. Samejima, S. et al. Effects of non-invasive spinal cord stimulation on lower urinary tract, bowel, and sexual functions in individuals with chronic motor-complete spinal cord injury: protocol for a pilot clinical trial. PLoS ONE 17, e0278425 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Samejima, S. Mapping the iceberg of autonomic recovery: mechanistic underpinnings of neuromodulation following spinal cord injury. Neuroscientist 30, 378–389 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  74. Schaeffer, A. J. & Nicolle, L. E. Urinary tract infections in older men. N. Engl. J. Med. 374, 562–571 (2016).

    Article  CAS  PubMed  Google Scholar 

  75. Christiaans, C. H. H. et al. Patient satisfaction, quality of life, and catheter-related complications in long-term urinary catheter users: a nationwide survey. World J. Urol. 40, 470 (2025).

    Article  Google Scholar 

  76. Hess, M. J., Zhan, E. H., Foo, D. K. & Yalla, S. V. Bladder cancer in patients with spinal cord injury. J. Spinal Cord Med. 26, 335–338 (2003).

    Article  PubMed  Google Scholar 

  77. Bergman, R. & Jesus, O. D. Patient Care Transfer Techniques (StatPearls, 2022).

  78. Feneley, R. C. L., Hopley, I. B. & Wells, P. N. T. Urinary catheters: history, current status, adverse events and research agenda. J. Med. Eng. Technol. 39, 459–470 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  79. Leslie, S.W., Tadi, P., Tayyeb, M. Neurogenic Bladder and Neurogenic Lower Urinary Tract Dysfunction (StatPearls, 2023).

    Google Scholar 

  80. Feifer, A. & Corcos, J. Contemporary role of suprapubic cystostomy in treatment of neuropathic bladder dysfunction in spinal cord injured patients. Neurourol. Urodyn. 27, 475–479 (2008).

    Article  PubMed  Google Scholar 

  81. Arnold, E. P., Palmer, N. B. & Anthony, A. Management of spinal cord injured patients by indwelling suprapubic catheterization. J. Urol. 154, 492–494 (1995).

    Article  PubMed  Google Scholar 

  82. Gibson, K. E., Neill, S., Tuma, E., Meddings, J. & Mody, L. Indwelling urethral versus suprapubic catheters in nursing home residents: determining the safest option for long-term use. J. Hosp. Infect. 102, 219–225 (2019).

    Article  CAS  PubMed  Google Scholar 

  83. Linsenmeyer, T. A. Catheter-associated urinary tract infections in persons with neurogenic bladders. J. Spinal Cord Med. 41, 132–141 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  84. Mandeville, P. Prevention and management of urinary tract infections among persons with a spinal cord injury: implications for nurses. Rehabil. Nurs. J. 51, 18–24 (2026).

    Article  Google Scholar 

  85. Fitzpatrick, M. A. & Nwafo, N. Urinary tract infection diagnostic and management considerations in people with spinal cord injury and neurogenic bladder. Infect. Dis. Clin. North Am. 38, 381–393 (2024).

    Article  PubMed  Google Scholar 

  86. Ma, S., Gu, J. & Fan, X. Original research: need to clamp indwelling urinary catheters before removal after different durations: a systematic review and meta-analysis. BMJ Open 13, 64075 (2023).

    Article  Google Scholar 

  87. Pannek, J. Transitional cell carcinoma in patients with spinal cord injury: a high risk malignancy? Urology 59, 240–244 (2002).

    Article  PubMed  Google Scholar 

  88. Taweel, W. A. & Seyam, R. Neurogenic bladder in spinal cord injury patients. Res. Rep. Urol. 7, 85–99 (2015).

    PubMed  PubMed Central  Google Scholar 

  89. Nseyo, U. & Santiago-Lastra, Y. Long-term complications of the neurogenic bladder. Urol. Clin. North Am. 44, 355–366 (2017).

    Article  PubMed  Google Scholar 

  90. Kalisvaart, J. F., Katsumi, H. K., Ronningen, L. D. & Hovey, R. M. Bladder cancer in spinal cord injury patients. Spinal Cord 48, 257–261 (2010).

    Article  CAS  PubMed  Google Scholar 

  91. Levien, P. et al. Squamous cell carcinoma of the urinary bladder in patients with chronic spinal cord injury: a case series. Spinal Cord Ser. Cases 14, 67 (2024).

    Article  Google Scholar 

  92. Michel, F. Incidence of bladder cancer in neuro-urological patients in France: a nationwide study. World J. Urol. 40, 1921–1927 (2022).

    Article  PubMed  Google Scholar 

  93. Böthig, R. et al. Incidental bladder cancer at initial urological workup of spinal cord injury patients. Spinal Cord. Ser. Cases 6, 55 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  94. Kirkali, Z. et al. Bladder cancer: epidemiology, staging and grading, and diagnosis. Urology 66, 4–34 (2005).

    Article  PubMed  Google Scholar 

  95. Fankhauser, C. D. et al. Diagnostic accuracy of ultrasonography, computed tomography, cystoscopy and cytology to detect urinary tract malignancies in patients with asymptomatic hematuria. World J. Urol. 39, 97–103 (2021).

    Article  CAS  PubMed  Google Scholar 

  96. Pannek, J., Rademacher, F. & Wöllner, J. Clinical usefulness of urine cytology in the detection of bladder tumors in patients with neurogenic lower urinary tract dysfunction. Res. Rep. Urol. 9, 219–223 (2017).

    PubMed  PubMed Central  Google Scholar 

  97. Chen, Y. C. et al. Bladder management strategies for urological complications in patients with chronic spinal cord injury. J. Clin. Med. 11, 6850 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  98. Salameh, A., Al Mohajer, M. & Daroucihe, R. O. Prevention of urinary tract infections in patients with spinal cord injury. CMAJ 187, 807–811 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  99. Bigarella, M. P. & Richards, K. A. Prostate cancer diagnosis and treatment for patients with neurogenic bladder: does the literature support a different approach? Curr. Bladder Dysfunct. Rep. 19, 195–202 (2024).

    Article  Google Scholar 

  100. Scott, P. A., Perkash, I., Mode, D., Wolfe, V. A. & Terris, M. K. Prostate cancer diagnosed in spinal cord-injured patients is more commonly advanced stage than in able-bodied patients. Urology 63, 509–512 (2004).

    Article  PubMed  Google Scholar 

  101. Jeong, S. H., Werneburg, G. T., Abouassaly, R. & Wood, H. Acquired and congenital spinal cord injury is associated with lower likelihood of prostate specific antigen screening. Urology 164, 178–183 (2022).

    Article  PubMed  Google Scholar 

  102. Ghatas, M. P. Race and age-related PSA testing disparities in spinal cord injured men: analysis of National Veterans Health Administration data. Fed. Pract. 40, S50–S57 (2023).

    PubMed  PubMed Central  Google Scholar 

  103. Shim, H. B., Jung, T. Y., Lee, J. K. & Ku, J. H. Prostate activity and prostate cancer in spinal cord injury. Prostate Cancer Prostatic Dis. 9, 115–120 (2006).

    Article  CAS  PubMed  Google Scholar 

  104. Zermann, D. H., Ishigooka, M., Doggweiler, R., Schubert, J. & Schmidt, R. A. Central nervous system neurons labeled following the injection of pseudorabies virus into the rat prostate gland. Prostate 44, 240–247 (2000).

    Article  CAS  PubMed  Google Scholar 

  105. Parisi, A. et al. Men with spinal cord injury have a smaller prostate volume than age-matched able-bodied men: a meta-analysis of case-control studies. Spinal Cord 59, 1210–1215 (2021).

    Article  PubMed  Google Scholar 

  106. Durga, A., Sepahpanah, F., Regozzi, M., Hastings, J. & Crane, D. A. Prevalence of testosterone deficiency after spinal cord injury. PM R 3, 929–932 (2011).

    Article  PubMed  Google Scholar 

  107. Fogg, R. W. et al. Defining abnormal prostate-specific antigen values for prostate cancer screening in the spinal cord injury population. J. Urol. 214, 374–382 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  108. Fried, L. P. et al. Frailty in older adults: evidence for a phenotype. J. Gerontol. A Biol. Sci. Med. Sci. 56, M146–M157 (2001).

    Article  CAS  PubMed  Google Scholar 

  109. Rockwood, K. et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 173, 489–495 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  110. Canli, S. et al. The role of Edmonton Frailty Scale in determining the postoperative complications in elderly: a prospective observational study. J. Coll. Physicians Surg. Pak. 34, 1518–1523 (2024).

    PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge S. D. Campbell for sharing his lived experience with spinal cord injury, which enriched our patient-centred perspective. The authors thank T. Miller for editorial assistance.

Author information

Authors and Affiliations

  1. International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Fiona Huang, Lucas Rempel, Katherine Anderson, Raza Malik & Andrei V. Krassioukov

  2. Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Fiona Huang, Lucas Rempel, Katherine Anderson, Raza Malik & Andrei V. Krassioukov

  3. Faculty of Medicine, University of Basel, Basel, Switzerland

    Matthias Walter

  4. University Antwerp Belgium Faculty GGW, Antwerp, Belgium

    Jean Jacques Wyndaele

  5. Faculty of Neuro-Urology (ret), University Clinic of Bonn, Bonn, Germany

    Ruth Kirschner-Hermanns

  6. Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Katherine Anderson & Andrei V. Krassioukov

  7. G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada

    Andrei V. Krassioukov

Authors
  1. Fiona Huang
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  2. Lucas Rempel
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  3. Matthias Walter
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  4. Jean Jacques Wyndaele
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  5. Ruth Kirschner-Hermanns
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  6. Katherine Anderson
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  7. Raza Malik
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  8. Andrei V. Krassioukov
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Contributions

F.H. researched data for the article. F.H. and L.R. contributed substantially to discussion of the content. F.H. wrote the article. All authors reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Andrei V. Krassioukov.

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Nature Reviews Urology thanks Hann-Chorng Kuo and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Huang, F., Rempel, L., Walter, M. et al. Neurogenic lower urinary tract dysfunction in ageing men with spinal cord injury. Nat Rev Urol (2026). https://doi.org/10.1038/s41585-026-01135-w

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