Neurogenic bladder


Refers to bladder dysfunction caused by neurologic damage.

Symptoms can include overflow incontinence, frequency, urgency, urge incontinence, and retention.

Associated risks of serious complications such as recurrent infection, vesicoureteral reflux, autonomic dysreflexia is high.

Diagnosis involves imaging, cystoscopy and urodynamic testing.

Treatment involves catheterization or measures to trigger urination.

Processes that impair bladder and bladder outlet afferent and efferent signaling can cause neurogenic bladder.

Causes may involve the CNS such as stroke, spinal injury, meningomyelocele, amyotrophic lateral sclerosis, Parkinson disease, multiple sclerosis, syphilis, peripheral nerve changes of diabetic, alcoholic, or vitamin B12 deficiency neuropathies, herniated disks, and damage due to pelvic surgery.

Bladder outlet obstruction due to benign prostatic hyperplasia, prostate cancer, fecal impaction, or urethral strictures often coexists and may exacerbate symptoms.

In flaccid neurogenic bladder, the bladder is hypotonic, volume is large, pressure is low, and contractions are absent.

Flaccid neurogenic bladder may be the result of peripheral nerve damage or spinal cord damage at the S2 to S4 level.

After acute cord damage, initial flaccidity may be followed by long-term flaccidity or spasticity, or bladder function may improve after days, weeks, or months.

In spastic bladder, urine volume is typically normal or small, and involuntary contractions occur.

Spastic bladder usually the result of brain damage or spinal cord damage above T12.

In spastic bladder contraction and external urinary sphincter relaxation are typically uncoordinated.

Mixed flaccid and spastic bladder may be caused by syphilis, diabetes mellitus, brain or spinal cord tumors, stroke, ruptured intervertebral disk, and demyelinating or degenerative disorders such as, multiple sclerosis, or amyotrophic lateral sclerosis.

Neural pathway damage that control voiding can render the bladder too flaccid or spastic.

Flaccid bladder tends to cause overflow incontinence, while a spastic bladder tends to cause frequency, urge incontinence and, with detrusor-sphincter dyssynergia, retention.

Evaluation include: Measuring postvoid residual volume, renal ultrasonography and serum creatinine measurement, and in many patients, cystoscopy, and cystometrography with urodynamic testing.

Other measures for flaccid bladder include increased fluid intake and intermittent self-catheterization.

Treatment for spastic bladder may include measures to trigger urination and/or measures used to treat urge incontinence, including drugs.

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