Neurogenic bladder dysfunction

Neurogenic bladder dysfunction, sometimes simply referred to as neurogenic bladder, is a dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of micturition (urination). Neurogenic bladder usually causes difficulty or full inability to pass urine without use of a catheter or other method.

Causes

Any condition that impairs bladder and bladder outlet afferent and efferent signaling can cause neurogenic bladder. It is often associated with spinal cord diseases (such as syringomyelia/hydromyelia), injuries like herniated disks, and neural tube defects including spina bifida. It may also be caused by brain tumors and other diseases of the brain, pregnancy and by peripheral nerve diseases such as: Diabetes, Alcoholism and Vitamin B12 deficiency. It is a common complication of major surgery in the pelvis, such as for removal of sacrococcygeal teratoma and other tumors.

Treatments

Catheterization methods range from intermittent catheterization, which involves no surgery or permanently attached appliances, to the creation of a stoma, which bypasses the urethra to empty the bladder directly.

Intermittent catheterization is the use, several times a day, of straight catheters (which are usually disposable or single-use products) to empty the bladder. This can be done independently by the patient, or with help, in the case that the patient lacks the dexterity to manage the catheter. For patients that are unable to tolerate disposable straight catheters, a Foley catheter allows continuous drainage of urine into a sterile drainage bag that is worn by the patient.

Other treatments involve creation of a stoma that is continent and readily accepts a catheter. These are known as Mitrofanoff mechanisms. An example of this treatment is the creation of an Indiana pouch. Additionally, a muscarinic agonist like Bethanechol may also be used, particularly in the postpartum or postoperative period. Function of the stoma may be augmented by periodic injections of botulinum toxin to relax one of the two sphincters involved in normal urination.^[1] The effect is longer lasting with botulinum toxin type A than with type B.^[2] This use of botulinum toxin is discussed at length in the French medical literature.^{[3][4][5][6][7]}

References