Neurogenic bladder dysfunction
Neurogenic bladder dysfunction, sometimes simply referred to as neurogenic bladder, is a dysfunction of the urinary bladder due to disease or injury of the central nervous system or peripheral nerves involved in the control of urination.
Neurogenic bladder usually causes difficulty - or full inability - to pass urine without use of a catheter.
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, peripheral neuropathy caused by prolonged exposure to Agent Orange, 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.
The diagnosis of a neuropathic bladder disorder depends on a complete history and physical (including neurologic) examination, as well as use of radiologic studies (voiding cystourethrography, excretory urography, computed tomography scanning, magnetic resonance imaging, when necessary); urologic studies (cystoscopy, ultrasound); urodynamic studies (cystometry, urethral pressure recordings, uroflowmetry); and neurologic studies (electromyography, evoked potentials).
Patients should be reevaluated often as recovery progresses.
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 who 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. The effect is longer-lasting with botulinum toxin type A than with type B. This use of botulinum toxin is discussed at length in the French medical literature.
- Akbar M, Abel R, Seyler TM, Gerner HJ, Möhring K (2007). "Repeated botulinum-A toxin injections in the treatment of myelodysplastic children and patients with spinal cord injuries with neurogenic bladder dysfunction". BJU Int. 100 (3): 639–45. doi:10.1111/j.1464-410X.2007.06977.x. PMID 17532858.
- Hirst GR, Watkins AJ, Guerrero K, Wareham K, Emery SJ, Jones DR, Lucas MG (2007). "Botulinum toxin B is not an effective treatment of refractory overactive bladder". Urology. 69 (1): 69–73. doi:10.1016/j.urology.2006.09.005. PMID 17270619.
- Game X, Karsenty G, Chartier-Kastler E, Ruffion A (2007). "[Treatment of neurogenic detrusor hyperactivity: enterocystoplasty]". Prog. Urol. (in French). 17 (3): 584–96. doi:10.1016/S1166-7087(07)92373-8. PMID 17622095.
- Karsenty G, Corcos J, Schurch B, Ruffion A, Chartier-Kastler E (2007). "[Pharmacological treatment of neurogenic detrusor hyperactivity: intradetrusor botulinum toxin A injections]". Prog. Urol. (in French). 17 (3): 568–75. doi:10.1016/S1166-7087(07)92370-2. PMID 17622092.
- Chartier-Kastler E, Ruffion A (2007). "[Treatment of vesicoureteric reflux and neurogenic bladder]". Prog. Urol. (in French). 17 (3): 470–2. PMID 17622079.
- Chartier-Kastler E, Comperat E, Ruffion A (2007). "[Disorders of bladder compliance and neurogenic bladder]". Prog. Urol. (in French). 17 (3): 442–7. doi:10.1016/s1166-7087(07)92345-3. PMID 17622074.
- Chenet A, Perrouin-Verbe B, Le Normand L, Labat JJ, Brunel P, Lefort M, Mathé JF (2007). "[Efficacy of repeat injections of botulinum A toxin to the detrusor in neurogenic bladder overactivity.]". Annales de Réadaptation et de Médecine Physique. 50 (8): 651–60. doi:10.1016/j.annrmp.2007.03.019. PMID 17490775.