Autonomous bladder training for neurogenic bladder: a randomized controlled trial
DOI:
https://doi.org/10.2340/jrm.v58.45818Keywords:
Neurogenic Bladder, Autonomous Bladder Function Training, Urodynamic Parameters, Urinary Tract Infection, Randomized Controlled TrialAbstract
Background: Neurogenic bladder causes impaired bladder emptying, urinary complications, and reduced quality of life. This trial evaluated whether structured multimodal autonomous bladder training improves bladder function in patients with neurogenic bladder.
Methods: In this single-centre randomized controlled trial, 168 adults were assigned 1:1 to autonomous bladder training plus routine rehabilitation care or routine care alone. The 4-week intervention included induced voiding, sensory awareness training, pelvic floor muscle training, bladder–sphincter coordination exercises, and bladder desensitization. The primary outcome was change in post-void residual urine volume (RUV) at 4 weeks. Secondary outcomes included urodynamic parameters, Neurogenic Bladder Symptom Score (NBSS), symptomatic urinary tract infection (UTI) requiring antibiotics, and adverse events.
Results: At 4 weeks, RUV improved more with autonomous bladder training than with routine care (adjusted mean difference in change, –55.8 mL; 95% CI, –64.7 to –46.9). Maximum urinary flow rate, maximum detrusor pressure, and NBSS also favoured the intervention. RUV reduction ≥50 mL occurred in 79.8% versus 42.9% of participants. Symptomatic UTI requiring antibiotics occurred in 9.5% versus 27.4%, although urine culture confirmation was incomplete. Exploratory 12-week follow-up suggested partial maintenance of benefit. Adverse events were uncommon, and no serious adverse events occurred.
Conclusions: Autonomous bladder training improved short-term urodynamic and patient-reported outcomes, with exploratory evidence of partial benefit maintenance at 12 weeks. Infection-related findings require cautious interpretation because culture confirmation was incomplete. Longer multicentre trials are warranted.
Downloads
References
Ginsberg DA, Boone TB, Cameron AP, Gousse A, Kaufman MR, Keays E, et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up. J Urol 2021; 206: 1106–1113. DOI: https://doi.org/10.1097/JU.0000000000002239
McKibben MJ, Seed P, Ross SS, Borawski KM. Urinary tract infection and neurogenic bladder. Urol Clin North Am 2015; 42: 527–536. DOI: https://doi.org/10.1016/j.ucl.2015.05.006
Lane G, Gracely A, Bassis C, Greiman SE, Romo PB, Clemens JQ, et al. Distinguishing features of the urinary bacterial microbiome in patients with neurogenic lower urinary tract dysfunction. J Urol 2022; 207: 627–634. DOI: https://doi.org/10.1097/JU.0000000000002274
Ross SS, Forster CS, Borawski K. Urinary tract infection and neuropathic bladder. Urol Clin North Am 2024; 51: 551–559. DOI: https://doi.org/10.1016/j.ucl.2024.06.009
Liao L. Evaluation and management of neurogenic bladder: what is new in China? Int J Mol Sci 2015; 16: 18580–18600. DOI: https://doi.org/10.3390/ijms160818580
Joshi AD, Shukla A, Chawathe V, Gaur AK. Clean intermittent catheterization in long-term management of neurogenic bladder in spinal cord injury: patient perspective and experiences. Int J Urol 2022; 29: 317–323. DOI: https://doi.org/10.1111/iju.14776
Jiang M, Deng J, Zhou G, Li S, Liu G. Risk factors for recurrent urinary tract infection in children with neurogenic bladder following clean intermittent catheterization. Urology 2022; 164: 224–229. DOI: https://doi.org/10.1016/j.urology.2021.12.027
Chaudhry R, Balsara ZR, Madden-Fuentes RJ, Wiener JS, Routh JC, Seed P, et al. Risk factors associated with recurrent urinary tract infection in neurogenic bladders managed by clean intermittent catheterization. Urology 2017; 102: 213–218. DOI: https://doi.org/10.1016/j.urology.2016.12.049
Funada S, Yoshioka T, Luo Y, Sato A, Akamatsu S, Watanabe N. Bladder training for treating overactive bladder in adults. Cochrane Database Syst Rev 2023; 10: CD013571. DOI: https://doi.org/10.1002/14651858.CD013571.pub2
Fernandes ACN, Jorge CH, Weatherall M, Ribeiro IV, Wallace SA, Hay-Smith EJC. Pelvic floor muscle training with feedback or biofeedback for urinary incontinence in women. Cochrane Database Syst Rev 2025; 3: CD009252. DOI: https://doi.org/10.1002/14651858.CD009252.pub2
Kajbafvala M, Ashnagar Z, Lucio A, Firoozeh F, Salehi R, Pashazadeh F, et al. Pelvic floor muscle training in multiple sclerosis patients with lower urinary tract dysfunction: a systematic review and meta-analysis. Mult Scler Relat Disord 2022; 59: 103559. DOI: https://doi.org/10.1016/j.msard.2022.103559
Wang X, Qiu J, Li D, Wang Z, Yang Y, Fan G, et al. Pressure-mediated biofeedback with pelvic floor muscle training for urinary incontinence: a randomized clinical trial. JAMA Netw Open 2024; 7: e2442925. DOI: https://doi.org/10.1001/jamanetworkopen.2024.42925
Wang X, Sun Z, Xu T, Fan G. Efficacy of supervised pelvic floor muscle training with a home-based biofeedback device for urinary incontinence in postpartum women: protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13: e069874. DOI: https://doi.org/10.1136/bmjopen-2022-069874
Jorge CH, Bø K, Chiazuto Catai C, Oliveira Brito LG, Driusso P, Kolberg Tennfjord M. Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 231: 51–66.e1. DOI: https://doi.org/10.1016/j.ajog.2024.01.001
Sheng Y, Carpenter JS, Ashton-Miller JA, Miller JM. Mechanisms of pelvic floor muscle training for managing urinary incontinence in women: a scoping review. BMC Womens Health 2022; 22: 161. DOI: https://doi.org/10.1186/s12905-022-01742-w
Goldstine J, Knox K, Beekman J, Cobussen-Boekhorst H, Conti A, Gray M, et al. A patient-centric tool to facilitate goal attainment scaling in neurogenic bladder and bowel dysfunction: path to individualization. Value Health 2021; 24: 413–420. DOI: https://doi.org/10.1016/j.jval.2020.10.023
Fitzpatrick MA, Nwafo N. Urinary tract infection diagnostic and management considerations in people with spinal cord injury and neurogenic bladder. Infect Dis Clin North Am 2024; 38: 381–393. DOI: https://doi.org/10.1016/j.idc.2024.03.012
Liu J, Bi Y, Liu Y, Tang L, Wang A. Value of sufficient clean intermittent catheterization in urinary tract infection and upper urinary tract protection in children with neurogenic bladder. J Pediatr Urol 2022; 18: 499.e1–499.e6. DOI: https://doi.org/10.1016/j.jpurol.2022.04.011
Additional Files
Published
How to Cite
License
Copyright (c) 2026 Yue Yang, Lianchi Li, Jing Ye, Hongxia Pan, Jianmei Zhang, Li Zeng, Yuyang Long, Xinling Gan
This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
