Neurogenic lower urinary tract dysfunction (NLUTD) significantly impacts quality of life and daily activities. While pharmacological and surgical treatments remain standard, conservative approaches such as manual therapy and biofeedback have shown potential in enhancing pelvic floor rehabilitation. This study hypothesizes that the combination of manual therapy and biofeedback leads to improved bladder function and quality of life in patients with NLUTD. The primary aim is to assess the effectiveness of this combined approach on lower urinary tract function and patient-reported outcomes. The secondary objectives include evaluating changes in detrusor overactivity, maximum cystometric capacity, and incontinence episodes.

This is a prospective, interventional, randomized controlled study including 128 patients diagnosed with NLUTD based on clinical assessment and urodynamic evaluation. Participants are randomly assigned into two groups:
●	Control group: Standard NLUTD management including bladder training, behavioral therapy, and, if needed, pharmacological treatment.
●	Intervention group: Standard NLUTD management combined with a structured program of manual therapy and biofeedback.
The intervention consists of two supervised sessions per week over 12 weeks. Manual therapy techniques focus on optimizing pelvic floor muscle function and bladder control, while biofeedback aims to enhance patient awareness and neuromuscular re-education. Outcome measures include:
●	Primary outcome: Changes in bladder function assessed via urodynamic parameters.
●	Secondary outcomes: Quality of life (measured using Qualiveen and SF-12), symptom scores (International Consultation on Incontinence Questionnaire – Short Form, ICIQ-SF), and incontinence episodes.

Preliminary findings indicate a significant improvement in bladder function and quality of life in the intervention group compared to controls. Key findings include:
●	Urodynamic outcomes:
○	Maximum cystometric capacity increased from 185.3 ± 45.2 mL to 312.7 ± 52.8 mL (p<0.001).
○	Detrusor overactivity episodes reduced by 41% (p=0.002).
○	Post-void residual volume decreased from 112.6 ± 37.1 mL to 68.9 ± 29.4 mL (p=0.008).
●	Patient-reported outcomes:
○	Qualiveen scores improved by 27% (p=0.004), indicating better health-related quality of life.
○	ICIQ-SF scores decreased from 15.2 ± 4.6 to 8.9 ± 3.7 (p=0.002), reflecting reduced symptom severity.
○	Weekly incontinence episodes dropped from 5.8 ± 1.9 to 2.1 ± 1.3 (p<0.001).

The combination of manual therapy and biofeedback appears to provide added benefits in NLUTD rehabilitation. Improvements in cystometric capacity, detrusor overactivity, and patient-reported outcomes suggest enhanced bladder control and symptom relief. These findings support the integration of conservative therapies into standard NLUTD management, particularly in resource-limited settings where access to advanced pharmacological or surgical interventions is restricted.

This study highlights the potential of manual therapy and biofeedback as adjunctive treatments for NLUTD, demonstrating significant functional and quality-of-life improvements. Given their non-invasive nature and cost-effectiveness, these interventions could be widely implemented, especially in African and Moroccan populations where access to specialized care is limited. Further research with larger cohorts and long-term follow-up is needed to confirm these findings and refine treatment protocols.