Neurogenic Bladder

Causes

Neurogenic bladder can occur at any age, but it is especially common among the elderly. Among the various causes are:

• Spinal cord injuries resulting in paralysis
• Other disorders such as syphilis, diabetes mellitus, stroke, ruptured or herniated intervertebral disk
• Degenerative neurological diseases such as multiple sclerosis and amyotrophic lateral sclerosis
• Congenital spine abnormalities such as spina bifida
• Long-term effects of alcoholism
• herper zoster

Signs and symptoms

The following are the most common symptoms of neurogenic bladder. However, each individual may experience symptoms differently. Symptoms may include:

• urinary tract infection
• kidney stones - these may be difficult to determine because you may not be able to feel pain associated with kidney stones if you have spinal cord abnormalities. Symptoms of kidney stones include:
  
  • chills
  • shivering
  • fever
    
• urinary incontinence
• small urine volume during voiding
• urinary frequency and urgency
• dribbling urine
• loss of sensation of bladder fullness

The symptoms of neurogenic bladder may resemble other conditions and medical problems. Always consult your physician for a diagnosis.

Diagnosis

Neurogenic bladder is diagnosed by carefully recording fluid intake and urinary output and by measuring the quantity of urine remaining in the bladder after voiding (residual urine volume). This measurement is done by draining the bladder with a small rubber tube (catheter) after the person has urinated. Kidney function also is evaluated by regular laboratory testing of the blood and urine. Cystometry may be used to estimate the capacity of the bladder and the pressure changes within it. These measurements can help determine changes in bladder compliance in order to assess the effectiveness of treatment. Doctors may use a cystoscope to look inside the bladder and tubes that lead to it from the kidneys (ureters). Cystoscopy may be used to assess the loss of muscle fibers and elastic tissues and, in some cases, for removing small pieces of tissue for biopsy.

Treatment

The goals of treatment are to maintain the integrity of the upper urinary tract, control infection, and prevent urinary incontinence through evacuation of the bladder, drug therapy, surgery or, less commonly, neural blocks and electrical stimulation.

Bladder evacuation

Techniques of bladder evacuation include Crede's method, Valsalva's maneuver, and intermittent self-catheterization.

Crede's method (application of manual pressure over the lower abdomen) and Valsalva's maneuver (performing forced exhalation against a closed glottis) promote complete emptying of the bladder. (For more patient-teaching information,)

After appropriate instruction, most patients can perform Crede's method themselves; however, even when performed properly, this method isn't always successful and doesn't always eliminate the need for catheterization.

Intermittent self-catheterization­more effective than either Crede's method or Valsalva's maneuver - has proved to be a major advance in the treatment of neurogenic bladder because it allows complete emptying of the bladder without the risks that an indwelling urinary catheter poses.

Drug therapy

In neurogenic bladder, drug therapy may include bethanechol and phenoxybenzamine to facilitate bladder emptying, and propantheline, methantheline, flavoxate, dicyclomine, and imipramine to facilitate urine storage.

Surgery

When conservative treatment fails, surgery may correct the structural impairment through transurethral resection of the bladder neck, urethral dilatation, external sphincterotomy, or urinary diversion procedures. Implantation of an artificial urinary sphincter may be necessary if permanent incontinence follows surgery for neurogenic bladder.