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Pharmacologic modification of therapeutic measures used in managing the neurogenic bladder.

In the past 2 years, no supravesical urinary diversions have been done for myelodysplasia at St. Louis University Medical Center. Twenty-six patients with neuropathic bladders have been managed by intermittent catheterization and mechanical devices. The addition of anticholinergic and alpha-adrenergic agents to the therapeutic regimen has markedly increased the numbers of satisfactory results. Based on this group of patients, we are encouraged to believe that supravesical urinary diversion is rarely necessary for the management of both the medical and social problems of the urinary tract associated with myelodysplasia.