A neurogenic bladder is a term for the lack of bladder control caused by an injury to the spine, brain, or nerves affecting afferent or efferent signaling. These nerves carry messages between the bladder and spinal cord, and direct the holding and release of urine. When the nerves fail to function, the symptoms of neurogenic bladder develop.
This condition affects millions of people around the globe. It can occur in conjunction with diseases like multiple sclerosis, Parkinson’s disease, and diabetes, but can also be brought on by injuries or illnesses like stroke, heavy metal poisoning, or pelvic surgery.
Symptoms and Types of Neurogenic Bladder
The primary symptom of neurogenic bladder is incontinence, where urine is retained to the point of overflow with constant dribbling. In men, erectile dysfunction is typically present as well. Other symptoms that can accompany incontinence include frequent urge to urinate, nocturia (nocturnal urination), and spastic paralysis. Intermittent bladder contractions leading to urine leakage are common.
With flaccid or hypotonic neurogenic bladder, the pressure inside the bladder is low and fluid volume is large. The bladder does not contract. This can be caused by spinal cord damage at S2 to S4 or by peripheral nerve damage.
On the other hand, a spastic bladder has a low or normal fluid volume with involuntary contractions. It can be caused by spinal cord damage above T12 or brain damage.
Flaccid and spastic bladder patterns are sometimes combined. This is seen in conditions such as syphilis, diabetes, brain or spinal cord tumors, ruptured intervertebral disk, stroke, or disorders that cause demyelination of the nerves (such as multiple sclerosis, amyotrophic lateral sclerosis, or other serious conditions).
Complications
People with neurogenic bladder are prone to complications. Those include frequent urinary tract infections and urinary calculi (solid particles), kidney swelling (hydronephrosis), backward flow of urine from the bladder to the kidneys (vesicoureteral reflux), as well as kidney disease.
Over the long term, untreated lower urinary tract dysfunction can lead to the loss of renal function. Risk factors include the loss of bladder compliance, chronic indwelling catheterization, and repeated episodes of pyelonephritis. Some other long term complications of neurogenic bladder are malignancy, refractory urinary incontinence, and nephrolithiasis (kidney stones).
Diagnostic Tests for Neurogenic Bladder
Neurogenic bladder is typically evaluated through postvoid residual volume, renal ultrasound, and serum creatinine initially. X-rays of the skull and spine and imaging of the bladder and ureters may also be needed.
If patients are not severely debilitated, further studies can be done using cystography to evaluate bladder capacity and ureteral reflux, cystoscopy for urine retention and bladder outlet obstruction, and cystometrography to measure pressure in the bladder.
Additionally, urodynamic testing - a test that show how much urine the bladder can hold - may be carried out to determine whether bladder contraction and sphincter relaxation are in sync.
Treatment Approaches
Neurogenic bladder can be treated with:
- Medication
- Urinary catheter
- Preventive antibiotics
- Bladder cuff
- Botox injections
- Electrical stimulation
When medical therapy for neurogenic bladder fails, surgery remains as one viable option. Surgery may enhance patient safety or quality of life to a greater extent than nonsurgical approaches. For example, in patients with neurogenic lower urinary tract dysfunction, surgery may correct difficulties with catheterization, refractory incontinence, or complications from chronic catheters.
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