Neurogenic bladder

Neurogenic bladder is a condition that causes a loss of bladder control due to nerve damage in the brain, spinal cord, or nerves. This damage can be caused by a number of diseases, injuries, or other conditions. The common causes include:

  • Normal-pressure hydrocephalus
  • Spinal cord injuries
  • Cerebral palsy
  • Traumatic brain injury
  • Stroke
  • Parkinson disease
  • Multiple sclerosis
  • Meningomyelocele
  • Spina Bifida
  • Diabetes mellitus
  • Dementia
  • Guillain-Barre syndrome
  • Tumors involving the central nervous system or spine

Studies have shown that neurogenic bladder is found in 40% to 90% of persons with multiple sclerosis (with detrusor hyperreflexia in 50% to 90% of cases), 37% to 72% in patients with Parkinson disease, 15% of all stroke patients and 70% to 84% of patients with spinal cord injuries.

For practical purposes, the two main types of neurogenic bladder are: 

Overactive bladder also known as spastic or hyper-reflexive bladder with a sudden or frequent urge to urinate, and with little or no bladder control (incontinence)

Underactive bladder or flaccid/ hypotonic bladder presenting more with retention of urine and also retention with overflow. Some people have symptoms of both types of neurogenic bladder, which is called mixed neurogenic bladder.

A detailed history and clinical examination are most important to find out the cause of the neurogenic bladder. MRI may be needed in cases of Multiple, sclerosis, Parkinson disease, spinal cord injury etc.

The specific investigations done are
a. Kidney function tests
b. Ultrasound scan of abdomen for residual urine
c. Cystoscopy of urethra and bladder
d. urodynamic studies including Uroflow rate. Filling and voiding cystometrogram and Electromyography. In some cases, videourodynamic studies need to be performed.

Treatment of neurogenic bladder

The goals of treating neurogenic bladder is to protect the upper urinary tract from damage and minimize permanent harm to the bladder and in maintaining urinary continence and improving the patient’s quality of life.  Treatment is generally broken down into behavioral interventions, medications, catheters, neuromodulation, and surgery, either alone or in combination.

  1. Behavioral and conservative measures can be helpful in selected individuals, such as those with cognitive impairment.
  2. Medications like Alpha-blocker or Anticholinergic medications
  3. Onabotulinumtoxin A (botulinum toxin)
  4. Catheters including Clean intermittent self-catheterization is the gold standard and recommended first-choice therapy for neurogenic bladder Foley catheters and Suprapubic tubes  and are used in those situations where there is no other reasonable choice, and intermittent catheterization is not possible
  5. Sacral Neuromodulation is a safe and effective, minimally invasive therapy that moderates poorly regulated or unregulated spinal cord reflexes and activity by blocking afferent input to the sacral spinal, primarily through S3 stimulation.
  6. Surgery likeAugmentation cystoplasty/ Sphincterotomy / Urinary diversion surgery

 

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