DEPARTMENT OF UROLOGY EDUCATION

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Dr Abraham Benjamin - Manager Medical InformaticsMr. Naresh Kumar - Coordinator Medical Informatics

Neurogenic Bladder

What is Neurogenic Bladder?

Neurogenic bladder is the loss of normal bladder function caused by damage to part of the nervous system.

The damage can cause the bladder to be underactive, in which it is unable to contract and unable to empty completely.

Anatomy of the Urinary Bladder

What happens in normal conditions ?

The muscles and nerves of the urinary system must function in a coordinated fashion with the bladder in order to perform its two major functions of storage and elimination of urine.

Nerves carry messages from the bladder to the brain and then from the brain to the muscles of the bladder telling them to tighten or release, allowing the bladder to empty during urination.

What are some risk factors for neurogenic bladder ?

Risk factors for neurogenic bladder include various birth defects, which adversely affect the spinal cord and function of the bladder, like spina bifida.

Tumors within the spinal cord. Traumatic spinal cord injury is also a major risk

factor for development of neurogenic bladder.

What are the symptoms of Neurogenic Bladder ?

Inability to control urination, also known as urinary incontinence is associated with the neurogenic bladder. This may be caused by abnormalities in bladder capacity or malfunction of control mechanisms such as the bladder neck and external urethral sphincter muscle that are important for the bladder's storage function.

Symptoms including a dribbling urinary stream, straining

during urination or inability to urinate may also be associated with neurogenic bladder.

What are the symptoms of Neurogenic Bladder ?

Urinary retention.

Increased bladder pressures from neurogenic bladders can be caused by the inability of the bladder muscle to relax properly and expand to store urine.

Stones may also form in the urinary tract of individuals with a neurogenic bladder caused by the stoppage of urine flow .

Abnormal backup of urine from the bladder to the kidney, also known as

vesicoureteral reflux(VUR), may develop as a means of releasing high pressure within the bladder.

A Urinary Tract Infection is of particular concern as Vesico Ureteral Reflux

may place the patient at significant risk for a severe kidney infection by transporting infected bladder urine directly to the kidneys.

How is Neurogenic Bladder Diagnosed ?

Complete medical history and physical examination is done

Bladder function tests including Urodynamic evaluations, which has two components CMG (Cystometrogram) which measures bladder function, capacity, compliance and voiding and storage pressures. Along with EMG (Electromypography) which help measure urethral sphincter tone and bladder coordination.

Imaging tests of the bladder and kidneys are performed.

How is Neurogenic Bladder Treated ?

The main goal of Urologic management is to prevent damage to the upper tracts (kidneys). The secondary goal is minimize any disabilities.

Treatment for neurogenic bladder fall the following categories: physical-psychological, electrical-stimulatory, and surgery.

How is Neurogenic Bladder Treated ?

Physical-psychological therapy Physical-psychological therapy, is also called timed voiding, It combines

willpower and exercise.

The patient is asked to keep a voiding diary, which is a daily record of the amount and time of fluid intake, times of urination, and episodes of leakage. The record creates a pattern that may initially allow patients to determine the times of the day they should be in close proximity to a bathroom.

These are also the times when a patient should attempt to urinate. The

intervals between voiding times are gradually extended as the patient gains control over voiding. This conditioning is often coupled with physical exercises, principally Kegel exercises, which strengthen pelvic muscles. The Valsalva maneuver, an exertion used to pass stool, may also be sufficient to empty a bladder.

How is Neurogenic Bladder Treated ?

Electrical-stimulatory therapyElectrical-stimulatory therapy is a recent advance.

Electrodes and a small stimulator are implanted in a minor surgical procedure. The electrodes are placed near targeted nerves. The stimulator is placed beneath the skin. The stimulator delivers electrical impulses that mimic those that would normally be delivered by nerves if they were undamaged.

How is Neurogenic Bladder Treated ?

Surgery Intermittent self Catheterization is frequently employed to ensure complete bladder

drainage. It involves the insertion of a thin tube through the urethra and into the bladder. A number of patients can learn to insert the catheter themselves. The therapy is called Clean Intermittent Catheterization (CIC).

Urethral stents, something like an internal catheter, can be surgically inserted through the

sphincter muscle to expand it and allow urine to be drained.

The sphincter can be surgically weakened by a procedure called sphincter resection, which removes a portion of the muscle or the muscle may be removed in its entirety in a sphincterotomy.

Artificial sphincters are a mechanical intervention. These devices consist of a cuff that fits around the bladder neck, a pressure regulating balloon and a pump that inflates the cuff. The balloon is placed beneath the abdominal muscles. The pump is placed in the labia in women and in the scrotum for men.

What can be expected after the treatment of

Neurogenic Bladder ?

A patient can expect extensive follow-up evaluation of bladder and kidney function. This may involve repeated X-rays, ultrasound, blood tests and bladder function tests.

Most issues in neurogenic bladder typically require constant attention and reevaluation.

Important Information

If you need more details about this condition or meet our team of Urologists for Consultation click on the link below.

http://www.ramayyapramila.com/

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