薦髓上之神經病變會造成尿道括約肌痙攣，道致排尿困難。當合併逼尿肌過度反射時，則可能同時有尿失禁症狀。治療方法可分為（1）降低尿道阻力促進尿液排空，以及（2）降低膀胱內壓保護腎臟、維持禁尿能力兩方面。降底尿道壓的方法包括：口服α-adrenergic阻斷劑、抗痙攣藥物、肛門伸展術、陰部神經阻斷、肉毒桿菌注射、尿道支架及括約肌切開術等。降低尿道壓後，需配合定期用力、膀胱刺激等方法以儘量排空尿確保底解尿壓及低殘尿量，以選免感染以及上尿路擴張等併發症。降低膀胱內壓的方法包括：口服藥物（如oxybutynin或flavoxate）、膀胱內灌注oxybutynin, capasaicin, 和resiniferotoxin、薦髓背神經根切除、膀胱擴大整形術等。膀胱壓力降低無法排尿則需配合定期間歇導尿。目前多方研究顯示，降低膀胱內壓配合間歇導尿，發生泌尿併發症的機率最低。尿道外括約肌痙攣伴隨逼尿肌無反射的案例，其低膀胱內壓對上尿路系統不造成威脅，其括約肌高張力維持了禁尿功能，既能保護腎功能又有良好生活品質，定期間歇導尿是最佳處理方式。治療方法的選擇除了依據膀胱與括約肌的動力學關係以外，也需要參考患者的年齡、性別、肢體功能、照顧者的支持度及個人意願等因素，由醫師與患者共同來決定最佳的治療方法。

Suprasacral lesions may cause spastic urethral sphincter and result in voiding dysfunction; when detrusor hyperreflxia is associated with this, urinary incontinence will be another clinical problem. Therapeutic strategies include (1) eliminating or diminishing the functional outflow obstruction created by sphincter dyssynergia or (2) decreasing detrusor hyperreflexia. The current methods for eliminating urethral obstruction include oral medications such as antipasmolytic and α-adrenolytic agents, anal stretching, pudendal nerveblock with phenol, transurethral sphincterotomy, and injection with botulinum A toxin. The purpose is to achieve balanced voiding with low leakage pressure (<40 cmH2O) and low post-voiding residual to prevent urinary tract complications. The goal of eliminating detrusor hyperreflexia can be achieved by taking anticholinergic agents like oxybutynin; musculolytic agents such as flavoxate; and intravesical infusion of oxybutynin, capassaicin, or resiniferotoxin; or by undergoing sacral dorsal rhizotomy or augmentation cystoplasty. Low intravesical pressure permits smooth excretion of urine from the upper urinary tract to the bladder and maintenance of urinary continence. However, intermittent catheterization is needed to evacuate the urine. According to the results of previous studies, self intermittent catheterization the low intravesical pressure is the best method of bladder management which has the least incidence of urological complications. With the combination of a weak detrusor and a spastic sphincter, clean intermittent self catheterization is again the method of choice. The bladder is emptied regularly, and patients normally remain continent in between. Long-term follow-up of patients with neuropathic voiding dysfunction treated with intermittent catheterization with or without anticholinergic agents, reveals minimal risk of febrile urinary tract infection and rare upper urinary track deterioration. Based on the urodynamic evaluation of detrusor and sphincter function as well as a patient’s age, sex, functional status, and personal habits, a proper strategy for bladder management can be determined individually.