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neurogenic bladder

Dysfunction of the urinary bladder caused by a lesion of the central nervous system or peripheral nervous system. Classification: 1) International Continence Society classification a) detrusor b) striated sphincter c) sensation 2) Flaccid vs spastic 3) motor, sensory, both a) pure sensory: diabetes b) pure motor: Parkinsonism, ALS, poliomyelitis Epidemiology: - 2/3 of nursing home patients with evidence of detrusor underactivity [3] Laboratory: - serum creatinine [2] Special laboratory: 1) neurologic evaluation 2) urologic evaluation a) radiologic studies b) urodynamic studies 1] detrusor function 2] sphincter weakness c) post-void residual volume may be increased 3) endoscopic studies Complications: 1) infection - asymptomatic bacteriuria was not a strong predictor of symptomatic urinary tract infection [4] 2) incontinence 3) autonomic dysreflexia 4) hydronephrosis 5) urinary calculus 6) sexual dysfunction Management: 1) non-surgical: self intermittent catheterization, most useful in flaccid neurogenic bladder - see post-void residual volume 2) pharmacologic a) improve sphincter resistance b) improve storage function - depends of initial bladder capacity, degree of spasticity - anticholinergics: atropine, bantine, probanthine, oxybutynin antihistamines: chlorpheniramine 3) surgical (may be used in conjunction with self-intermittent catheterization) a) sphincterotomy b) bladder augmentation c) artificial sphincter d) urinary diversion to continent reservoir e) urinary diversion to a conduit f) bladder neck reconstruction g) bladder suspension

Related

detrusor hyperactivity with impaired bladder contractility (DHIC) urinary bladder

General

underactive bladder; bladder atony chronic neurologic disease

References

  1. Nerve Disease and Bladder Control http://kidney.niddk.nih.gov/kudiseases/pubs/nervedisease/index.htm
  2. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  3. Taylor JA 3rd, Kuchel GA. Detrusor underactivity: Clinical features and pathogenesis of an underdiagnosed geriatric condition. J Am Geriatr Soc. 2006 Dec;54(12):1920-32. Review. PMID: 17198500
  4. Tornic J, Wollner J, Leitner L et al. The challenge of asymptomatic bacteriuria and symptomatic urinary tract infections in patients with neurogenic lower urinary tract dysfunction. J Urol 2020 Mar; 203:579. PMID: 31526261 https://www.auajournals.org/doi/10.1097/JU.0000000000000555