Neurogenic lower urinary tract dysfunction in ageing men with spinal cord injury.

The management of neurogenic lower urinary tract dysfunction in ageing men with spinal cord injury is defined by the compounding interaction between prostate enlargement, neurogenic detrusor overactivity and detrusor-sphincter dyssynergia. The effects of spinal cord injury and an ageing bladder create unique challenges, including a 16-28-fold increased risk of urinary bladder cancer and a high prevalence of catheter-related complications. Importantly, although clean intermittent catheterization is the gold standard for treating lower urinary tract dysfunction, in many elderly patients, functional decline forces a transition to indwelling catheters, necessitating a shift in care strategy. Furthermore, prostate procedures such as transurethral resection of the prostate (TURP) and holmium laser enucleation, which are commonly carried out in older men, carry an increased risk of complications, including autonomic dysreflexia. Integrated, age-stratified guidelines are currently missing. Thus, a proactive, patient-centred framework for lifelong urological care is needed and should incorporate frailty assessments, sophisticated diagnostics to disentangle detrusor sphincter dyssynergia from prostate enlargement, and personalized management pathways to preserve renal function and quality of life.