Is There Still a Role for Bladder Augmentation and Urinary Diversion for Neurogenic Bladder in the Era of Onabotulinumtoxin?

Abstract Purpose of Review Management of neurogenic bladder is aimed at maintaining safe bladder storage pressures to prevent upper urinary tract deterioration. Implementation of intradetrusor onabotulinumtoxinA (OBTA) has had a profound impact on management options for patients suffering from neurogenic bladder lower urinary tract dysfunction, necessitating re-evaluation of the role of bladder augmentation and urinary diversion. This review examines current evidence on the shifting role of these surgical interventions in an era with chemodenervation. Recent Findings Following FDA approval of Intradetrusor OBTA in 2011, augmentation cystoplasty volumes have declined but have not disappeared from clinical practice. It is a minimally invasive procedure that involves cystoscopic injection of 200 units into the detrusor layer of the bladder. Efficacy ranges between 6 and 12 months and it effectively reduces intradetrusor pressure, thus protecting the upper urinary tracts and reducing incontinence episodes. Surgical intervention via augmentation cystoplasty or urinary diversion will continue to play a role in those cases refractory to or intolerant of chemodenervation. Summary OBTA has significantly reshaped the management of neurogenic bladder, however, the role of bladder augmentation and urinary diversion continue to play a critical role in a small subset of patients, particularly with refractory, high-pressure, and complex cases where minimally invasive approaches are ineffective or contraindicated.