# Complications and Risk Factors of Neurogenic Bladder: A Delphi Consensus

## TL;DR

This study identifies key risk factors and complications of neurogenic bladder through expert consensus, aiming to improve patient management and prevent serious issues like kidney failure.

## Contribution

A Delphi consensus process produced validated risk factors and complications for neurogenic bladder, offering a structured framework for clinical assessment.

## Key findings

- 22 expert-approved proposals were validated, including six complications and 16 risk factors.
- Key risk factors include spinal cord injury, urodynamic characteristics, and catheter use.
- Current literature lacks validated criteria, emphasizing the need for evidence-based risk stratification.

## Abstract

Patients with neurogenic bladder may experience complications in the upper urinary tract, such as renal failure, febrile urinary tract infection, or autonomic dysreflexia. Special attention should be given to patients with spinal cord injury, spina bifida, or multiple sclerosis.

Lower urinary tract symptoms secondary to neurogenic bladder impact quality of life and symptom burden significantly. These conditions are also associated with serious complications, including febrile urinary tract infections (UTIs) and impaired renal function. This study aimed to specify and rank the neurogenic bladder risk factors, their consequences, and finally the induced complications observed in neurourology.

We conducted a Delphi consensus between October 2023 and April 2025. A steering committee performed a comprehensive literature review and drafted initial proposals. A review committee and a multidisciplinary expert panel were formed to evaluate and rate the proposals. The standard Delphi methodology was followed throughout.

After three rounds, 22 proposals were validated. Six proposals addressed the complications (renal failure, febrile UTIs, and autonomic dysreflexia), while 16 focused on risk factors, including disease modality (spinal cord injury and myelomeningocele), urodynamic characteristics (detrusor leak point pressure ≥40 cmH2O and low bladder compliance), and treatment-related risk factors (use of indwelling or suprapubic catheters). This consensus allows to specification and prioritization of the risk factors, thus providing clinical elements for the assessment and follow-up of patients with neurogenic bladder. While expert agreement was generally strong, the process highlighted a significant lack of validated criteria in the current literature. Most urodynamic thresholds are derived from small, retrospective studies, and carried out in specific populations. The findings underscore the need for better-defined, evidence-based risk stratification in neurourology.

This consensus validated 22 expert-approved proposals, including six addressing the complications and 16 identifying the risk factors associated with neurogenic bladder.

This expert’s consensus provides a better understanding of upper urinary tract complications for patients with neurogenic bladder. It may help practitioners to better distinguish high-risk patients from low-risk patients and improve their management to avoid potential complications (renal failure, urinary tract infections, and other complications).