Neurogenic bladder is a voiding disorder resulting from improper functioning of the urinary system. What are the causes of urination control problems? How is the neurogenic bladder treated?

Neurogenic bladderis not a disease in itself, but only a symptom or consequence of other pathologies. It can occur, for example, in the course of strokes, tumors, Parkinson's disease or multiple sclerosis, which damage micturition centers in the central nervous system. Neurogenic bladder is also caused by other diseases of the spinal cord, such as accidental injury, spina bifida, spinal hernia, compression of the spinal cord by a tumor, and sometimes also during pregnancy. Diabetes mellitus and AIDS, which lead to peripheral neuropathy after many years, are considered to be the two main causes of neurogenic blistering in this mechanism. Other disease entities leading to the development of this complication include:

  • chronic alcoholism
  • vitamin B deficiency12
  • operational complications
  • Heine-Medin disease
  • nervous system syphilis
  • Guillain Barre band

Neurogenic bladder: types of disorders

The division of disorders that define the neurogenic bladder is primarily influenced by the result of the patient's urodynamic examination, which precisely determines which element responsible for micturition is damaged, and not - as it was once believed - the site of damage to the nervous system. Therefore, we can distinguish:

  • detrusor hyperactivity with detrusor-sphincter dyssynergy - it means that both the detrusor and the external urethral sphincter contract, which under physiological conditions should relax; this type of disorder generates the highest pressure in the upper floor of the urinary system, which can quickly result in kidney failure
  • areflexia or detrusor hyporeflexia with detrusor-sphincter dyssynergy - detrusor relaxation is accompanied by constant contraction of the external urethral sphincter, resulting in complete urinary retention in the bladder
  • areflexia or detrusor hyporeflexia with decreased external sphincter tone resulting in urinary incontinence
  • detrusor overactivity with sphincter insufficiencyexternal urethra, which manifests as increased urinary incontinence

Neurogenic bladder diagnosis

Neurogenic bladder should be suspected in all patients who, having any disease or dysfunction of the nervous system, could develop this complication. The study of choice in these patients is the urodynamic test, which will show in detail the type of bladder dysfunction, the mechanism of voiding and possible residual urine in the bladder. In these patients, an ultrasound examination should also be performed, which will show any disturbances in the upper levels of the urinary tract. A voiding diary kept by patients is also useful, in this way they monitor the amount and frequency of urination during the day.

Worth knowing

Urination - regulationAs the bladder is filled, its walls gradually stretch. Their high stress sends information to the centers in the brain that are responsible for micturition. The cortical center is responsible for conscious and controlled urination, while the other center located in the bridge is responsible for an unconditional reflex, i.e. one that is not subject to our will. This means that we only control the micturition up to a certain point. The cerebral cortex develops over the course of life, which is why young children urinate uncontrollably. This skill is not acquired until between the ages of one and three. Any uncontrolled micturition after this period is a pathological symptom that should always be included in the diagnosis. In addition to the centers located in the brain, two centers in the spinal cord are also responsible for the control of voiding: sympathetic at the level of Th10-Th 12 and parasympathetic at the level of S2-S4. Simply put, the sympathetic nervous system fills the bladder and keeps urine in it by contracting the internal urethral sphincter. The role of the parasympathetic system is to "switch off" the function of the sympathetic nervous system, which will cause the internal sphincter to relax, and it also causes the detrusor muscle to contract. Both processes lead to conscious and controlled urination. Both of these systems act antagonistically to each other. Peripheral nerves, such as the labia nerve, also play an important role in the regulation of voiding. It innervates the external urethral sphincter, which we can tighten or relax as we please.

Neurogenic bladder - treatment methods

The treatment of the neurogenic bladder depends largely on the disorder we are dealing with. With an overactive detrusor, cholinolytic drugs (for example, solifenacin or oxybutanine) can be used, whichwill lower the pressure in the bladder. If pharmacological treatment is unsuccessful, there is an option to inject the botulinum toxin detrusor into the muscle, which will relax the muscle for about six months.

It is sometimes necessary to incision the muscle of the external urethral sphincter to relieve pressure in the urinary tract. A patient who suffers from areflexia or hyporeflexia of the bladder can urinate using an abdominal pressure pump, which will support a weakened bladder. The weakened muscle of the external urethral sphincter can be strengthened by injecting, for example, with collagen.

If, despite the implemented measures, urine remains in the bladder, a self-catheterization attempt should be made by the patient. Self-catheterization is the patient's self-insertion of a Nelaton catheter into the bladder. It is much thinner than the popular Foley catheter, making this procedure possible for every patient at home. This operation should be repeated five to seven times a day, necessarily under sterile conditions. Please note that each catheter is for single use only.

Patients with neurogenic bladder are provided with 120 catheters a month, the rest must be purchased from their own pocket.

If the patient cannot perform this procedure at home for various reasons or has a severe, recurrent urinary tract infection, a suprapubic fistula procedure should be performed, through which the urine will be led outside.

Neurogenic bladder: complications

For patients with neurogenic bladder, urinary incontinence is a major problem, which is primarily an embarrassing social problem. In addition, chronic contact of urine with the skin of the genital area can lead to dermatitis, blemishes, and wounds that can develop into very painful ulcers. Urine remaining in the bladder is an ideal environment for bacteria to multiply, which is why it is so important to remove it regularly. Unfortunately, frequent catheterization also promotes the introduction of bacteria into the bladder, but the sterility of the procedure minimizes this risk.

Urinary tract infections can lead to urosepsis, which is a generalized infection of the body.

In patients with neurogenic bladder, who are "bedridden" due to their disease, other dangers, such as bedsores or respiratory system infections, should not be forgotten. Patients with neurogenic bladder on a urinalysis will most often show abnormalities indicating an infection,because it is not possible to remove all bacteria from the urinary tract in these patients. Despite this, it is not recommended to use antibiotics for prophylaxis, they should be allowed to treat only symptomatic patients. Neurogenic bladder is a difficult entity to treat as its cause is, unfortunately, irreversible in many cases. Currently, however, both pharmacological and surgical methods are known that allow patients to function normally. First of all, it is necessary to take care of the hygiene of the urogenital area and regular removal of urine from the bladder, which will protect the patient from the harmful consequences of this disease.

Category:

Urology and Nephrology