Autonomous bladder training for neurogenic bladder: a randomized controlled trial

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.