Introduction
Spinal cord injury (SCI) is a major cause of lifelong morbidity [1]. Current papers reported an incidence rate of 54 cases per one million, according to US data [2]. Although a declining incidence in the young population was prevalent, as well as some improvements in overall life quality, , the management of a neurogenic bladder after an SCI is still a challenging and crucial issue [3-6]. After an SCI, neurogenic bladder dysfunction may be present as neurogenic detrusor overactivity (NDO) or sphincter detrusor dyssynergia (DSD), which are due to SCI in the suprasacral levels, or as detrusor hypoactivity or complete areflexia as a result of damage to the sacral spinal cord [7]. The management of an underactive detrusor has mainly relied on active usage of clean intermittent catheterization, which is lifesaving [8]. On the other hand, the management of a neurogenic overactive detrusor is based on medical therapeutics that act on the receptors of the detrusor muscle cells [9]. Blockers of the acetylcholine receptors, namely anticholinergics, and an agonist of the beta-3 adrenergic receptors, mirabegron, are usually used as an initial management choice, either in combination or as a single therapy. Due to the contemporary clinical guidelines, unresponsive patients are recommended to be considered for Botulinum Toxin-A injections to the bladder wall, which is more invasive than an oral treatment [11]. With the aim of providing an option to these patients, several molecules have been reported to be successful in an experimental fashion [12]. Among them, gabapentin, a sodium channel blocker, has also been found to be clinically beneficial in suppressing the detrusor contractions with an acceptable side effect profile in both adults and children, as well as in neurogenic overactive bladder as in overactive bladder syndrome [13-18]. In this paper we report the results of a single neuro-urology working group that comprises 27 adult patients who did not respond to the combination of an anticholinergic and mirabegron and were treated with add-on gabapentin therapy.