This reality became particularly apparent to me during an education session I led through the peer program at Spinal Cord Injury British Columbia, a provincial non-profit organization dedicated to supporting individuals living with SCI. Among the attendees, many older adults spoke candidly about the challenges they faced navigating their urological health, and the uncertainty surrounding what to expect as they aged. What emerged was a clear gap in our conceptualization of the intersection between ageing and neurogenic bladder dysfunction. Our audience was not experiencing these issues in isolation, but as a continuum that evolves over time.
These conversations inspired our narrative review, “Neurogenic lower urinary tract dysfunction in ageing men with spinal cord injury”, published in Nature Reviews Urology. We explore the interplay among SCI-related urological dysfunction (including NLUTD), catheter-based management, and age-related conditions such as benign prostatic hyperplasia (BPH) and urologic malignancies, aiming to better align clinical frameworks with patients' lived experiences.
Building on these patient perspectives, our review reframes urological care in ageing men with SCI as a compounding, dynamic interaction rather than as two separate processes. We identified four key challenges.
First, a dual pathophysiology of bladder outlet obstruction emerges. Neurogenic detrusor overactivity and detrusor sphincter dyssynergia can coexist with BPH in ageing men, creating a “double obstruction” that is difficult to diagnose and carries meaningful clinical consequences. Symptom-based approaches are often unreliable, and definitive management merits careful physiological assessment with urodynamics.
Second, individuals with SCI require unique considerations when it pertains to urologic procedures. Prostate interventions require autonomic dysreflexia precautions; outcomes of procedures such as transurethral resection of the prostate are poor if detrusor sphincter dyssynergia is misidentified as the primary cause of obstruction, highlighting the necessity of accurate urodynamic diagnosis with expert interpretation to guide intervention.
Third, functional decline drives urological decision-making. While clean intermittent catheterization remains the gold standard for bladder management, many individuals transition to indwelling catheterization due to age-related impairments in dexterity, vision, cognition, or overall frailty, rather than failure of the bladder itself. These transitions should be viewed as expected adaptations over the lifespan, requiring proactive planning and patient-centred discussion.
Fourth, the long-term risks associated with chronic bladder management are substantial. Ageing men with SCI face a markedly increased risk of squamous cell carcinoma of the bladder due to chronic catheter-related inflammation, often presenting at younger ages and more advanced stages. Paradoxically, while prostate cancer incidence is lower, diagnosis occurs more often at advanced stages, underscoring the need for tailored surveillance.
Current urological frameworks separate neurogenic bladder and age-related disease, but patients experience both simultaneously and synergistically. Our review advocates a proactive, lifelong model of care that integrates frailty assessment, anticipates functional transitions, and prioritizes quality of life alongside transitional outcomes, moving beyond reactive management toward a framework that aligns with the lived experience of aging patients with SCI.
Written by: Lucas Rempel, BSc, Fiona Huang, MHSc, and Andrei V. Krassioukov, MD, PhD,
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.