neurogenic bladder

Introduction

Dysfunction of the urinary bladder caused by a lesion of the central nervous system or peripheral nervous system.

Classification

• International Continence Society classification
  • detrusor
  • striated sphincter
  • sensation
• Flaccid vs spastic
• motor, sensory, both
  • pure sensory: diabetes
  • pure motor: Parkinsonism, ALS, poliomyelitis

Epidemiology

• 2/3 of nursing home patients with evidence of detrusor underactivity

Laboratory

• serum creatinine

Diagnostic procedures

• neurologic evaluation
• urologic evaluation
  • radiologic studies
  • urodynamic studies
    • detrusor function
    • sphincter weakness
  • post-void residual volume may be increased
• endoscopic studies

Complications

• infection
  • asymptomatic bacteriuria was not a strong predictor of symptomatic urinary tract infection
• incontinence
• autonomic dysreflexia
• hydronephrosis
• urinary calculus
• sexual dysfunction

Management

• non-surgical: self intermittent catheterization, most useful in flaccid neurogenic bladder
  • see post-void residual volume
• pharmacologic
  • improve sphincter resistance
  • improve storage function
    • depends of initial bladder capacity, degree of spasticity
    • anticholinergics: atropine, bantine, probanthine, oxybutynin antihistamines: chlorpheniramine
• surgical (may be used in conjunction with self-intermittent catheterization)
  • sphincterotomy
  • bladder augmentation
  • artificial sphincter
  • urinary diversion to continent reservoir
  • urinary diversion to a conduit
  • bladder neck reconstruction
  • bladder suspension

More general terms

• underactive bladder; bladder atony
• chronic neurologic disease

Additional terms

• detrusor hyperactivity with impaired bladder contractility (DHIC)
• urinary bladder

Patient information

neurogenic bladder patient information