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.