Neurogenic bladder
Neurogenic bladder is dysfunction of bladder storage or emptying caused by disease or injury of the central or peripheral nervous system, producing either a spastic, high-pressure bladder with urgency incontinence or an atonic, high-volume bladder with retention and overflow incontinence depending on lesion location. Diagnosis rests on the neurologic history and exam with urodynamic testing, and management is centered on a regular, low-pressure emptying regimen, most often clean intermittent catheterization, to protect renal function and prevent infection.
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What this article covers
- Overview
Neurogenic bladder is dysfunction of the urinary bladder caused by disease or injury of the central nervous system or the peripheral nerves that control urination, producing either failure to store urine, failure to empty urine, or both.
- Epidemiology
Common after traumatic spinal cord injury, with the pattern set by injury level (suprasacral versus sacral/conus) and completeness.
- Risk factors
Traumatic spinal cord injury, whose level and completeness sets the pattern (suprasacral spasticity versus sacral/peripheral atonia).
- Pathophysiology
Normal micturition requires coordination between the pontine micturition center, spinal pathways, and the sacral micturition center (S2-S4), which relaxes the urethral sphincter as the detrusor contracts to allow low-pressure voiding.
- Clinical features
Symptoms follow the lesion pattern: suprasacral lesions cause urgency, frequency, and urge incontinence from an overactive bladder, while sacral/peripheral lesions cause hesitancy, weak stream, and…
- Differential diagnosis
Benign prostatic hyperplasia: obstructive lower urinary tract symptoms and elevated postvoid residual in an older man, but no neurologic lesion or abnormal S2-S4 exam.
- Diagnosis
Neurogenic bladder is diagnosed by correlating a known or newly identified neurologic lesion with a characteristic bladder dysfunction pattern on history, exam, and urodynamic testing; urodynamic…
- Management
First, decompress an acutely distended or retaining bladder with urethral catheterization (suprapubic if urethral access is not feasible), and treat any concurrent urinary tract infection before starting a chronic regimen.
- Complications
Upper urinary tract deterioration (hydronephrosis, vesicoureteral reflux, pyelonephritis, progressive chronic kidney disease) from sustained high storage/voiding pressure, the most serious long-term…
- Prognosis
Renal function is largely preserved when a regular, low-pressure emptying regimen (most often clean intermittent catheterization) is established and maintained, the single most outcome-determining intervention.
- Prevention
Start a regular, complete bladder-emptying schedule (clean intermittent catheterization 4-6 times daily, or scheduled voiding for a compliant low-pressure bladder) as soon as a neurogenic pattern is…
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