Neurogenic Voiding Dysfunction in Spinal Cord Injury and Stroke: Urodynamic Evaluation, Functional Classification, and Therapeutic Strategies

Many patients with injuries to their central nervous system, especially those who have had a stroke or a spinal cord injury, have neurogenic voiding dysfunction. It happens when patients can't control their bladder voluntarily, which can make them feel urgency, experience leaks, or have trouble emptying their bladder. If not treated right away, it can cause infections, damage to the bladder, or even kidney problems over time. This review will explain how this type of dysfunction works, how it is diagnosed, and what treatment options are available. It will mostly focus on stroke and spinal cord injuries. To do this, recent studies that were published between 2019 and 2025 on PubMed, Scopus, and ScienceDirect were reviewed. The main focus was on studies that were clinically relevant and had strong methods. Symptoms may vary based on which part of the nervous system is affected. Injuries that are higher up the spinal cord tend to cause an overactive bladder and poor coordination between the sphincter and bladder, while injuries on a lower spinal cord level, particularly sacral ones, often lead to an unreactive bladder. A diagnosis is generally made through a physical exam and diagnostic tests, including urodynamics, uroflowmetry, and ultrasound. For treatment, options include clean intermittent catheterization, antimuscarinic or botulinum toxin medications, neuromodulation, and, in severe cases, surgery. Regular follow-ups are crucial to avoid complications such as kidney failure, kidney stones, or infections. Managing this condition requires a collaborative approach. Nurses, therapists, neurologists, urologists, and rehabilitation specialists all play a crucial role in aiding patients to improve their quality of life and prevent further health complications.