What is a Neurogenic Bladder?

Urinary bladder dysfunction caused by damage to the central nervous system or peripheral nerves that control urination is called neurogenic bladder. Poor urine or urinary retention is one of the most common symptoms. The urinary complications, such as upper urinary tract damage and renal failure, are the main causes of death.

Basic Information

English name: neurogenic bladder
Visiting department: Urology
Common locations: bladder

Common causes: Cerebrovascular accident, craniocerebral tumor, diabetes, alcoholism, drug abuse, etc.
Common symptoms: Frequent urination, urgency, urinary retention, erectile dysfunction, sexual dysfunction, etc.

Causes of neurogenic bladder

All diseases that may affect the neural regulation of urinary storage and urination can cause bladder and urethral dysfunction.

Central nervous system factors

Including cerebrovascular accidents, craniocerebral tumors, normal pressure hydrocephalus, cerebral palsy, mental retardation, basal ganglia lesions, multiple system atrophy, multiple sclerosis, spinal cord disease, intervertebral disc disease, and spinal stenosis.

2. Peripheral nervous system factors

Diabetes, alcohol, drug abuse, and other uncommon neuropathies: porphyria, sarcoidosis.

3. Infectious diseases

Acquired immunodeficiency syndrome, type infectious polyradiculitis, shingles, human T lymphocyte virus infection, Lyme disease, polio, syphilis, and tuberculosis.

4. Iatrogenic factors

Spinal surgery, radical pelvic surgery such as radical rectal cancer surgery, radical hysterectomy, radical prostate cancer surgery, regional spinal anesthesia, etc.

5. Other factors

Hinman syndrome, myasthenia gravis, systemic lupus erythematosus, and familial amyloidosis.

Clinical manifestations of neurogenic bladder

Urogenital symptoms

(1) Lower urinary tract symptoms: including urgency, frequent urination, nocturia, urinary incontinence, enuresis, dysuria, incomplete bladder emptying, urinary retention, and dysuria.

(2) Symptoms of sexual dysfunction: genital area sensitivity, erectile dysfunction, abnormal orgasm, abnormal ejaculation, hyposexuality, etc.

2. Other symptoms

In addition to the symptoms of urination, it may be accompanied by intestinal symptoms, neurological symptoms, etc .: constipation, fecal incontinence, perineal sensation loss or loss, limb paralysis, etc.

Neurogenic bladder examination

Physical examination

(1) Anal sphincter tension test Anal sphincter relaxation, indicating inactivity or decreased activity of the spinal cord center, excessive contraction of the anal sphincter, indicating hyperreflexia of the central spinal cord.

(2) Anal reflex test stimulates the skin around the anus, such as anal contraction indicates the presence of spinal cord activity.

(3) The bulbocavernosus reflex test stimulates the penis head or clitoris, causing contraction of the anal sphincter, indicating the presence of spinal cord activity.

2. Ice water test

If the spinal cord is injured above the center of the spinal cord, the ice water is vigorously ejected within a few seconds after injecting ice water into the bladder; if the spinal cord is injured below the center of the spinal cord, there is no such reaction.

3. Urodynamics examination

Can reflect detrusor hyperreflexia or no detrusor reflex and urethral sphincter function.

4. Excretory cystourethrography

Visible trabecular wall formation, diverticulum and typical Christmas tree-like bladder. Dynamic observation showed detrusor abnormal contraction, abnormal coordination between detrusor contraction and sphincter inside and outside the urethra, and increased residual urine volume.

5.CT, MRU and nuclide inspection

Can clearly display the upper urinary tract anatomy and functional information.

6. Bladder urethroscopy

Can understand the bladder urethral morphology, bladder ureteral reflux and so on.

A series of imaging tests, such as intravenous urography (excretion urography), ultrasound, cystography and urethrography, CT and MRU, etc., can help evaluate the degree of secondary damage and disease of the neurogenic bladder Progress and can show urinary tract stones. Bladder urethroscopy can determine the extent of bladder outflow tract obstruction. A series of intravesical pressure examinations during the recovery period of the hypotonic bladder can provide a detrusor functional capacity index and further indicate the prospect of rehabilitation. Urodynamic measurements, electromyograms of the sphincter, and urethral pressure maps all contribute to the diagnosis. Renal function test reflects the degree of impaired upper urinary tract function.

Patients with urinary system infection may have positive red blood cells, white blood cells, and urine cultures.

Neurogenic bladder diagnosis

Medical history

(1) Those with urination dysfunction accompanied by defecation dysfunction (such as constipation, fecal incontinence, etc.) may have neuropathic meridian bladder.

(2) Pay attention to the history of trauma, surgery, diabetes, poliomyelitis, or history of drug application.

(3) Pay attention to whether there is a decrease or loss of sensation such as urination, bladder swelling, etc. If there is a significant decrease or loss of sensation in the bladder, a neurogenic bladder can be diagnosed.

2. check

(1) A neurogenic bladder can be diagnosed when there is a decrease in perineal sensation and anal sphincter tone loss or enhancement, but the lack of these signs cannot rule out the possibility of a neurogenic bladder.

(2) Pay attention to whether there are deformities such as spina bifida, meningocele, and sacral dysplasia.

(3) Residual urine, but no mechanical obstruction of lower urinary tract.

(4) Electrical stimulation of the spinal cord reflex test. This method mainly tests whether the reflex arc nerves of the bladder and urethra are intact (ie, whether the lower motor neurons are diseased) and whether there are neurons from the cerebral cortex to the genital nucleus (spine center) Disease (with or without upper motor neuron disease), therefore, this test can be diagnosed as a neurogenic bladder, and it can distinguish between lower motor neuron disease (non-reflex detrusor muscle) and upper motor neuron disease (depressurization) Hyperreflexia).

Differential diagnosis of neurogenic bladder

Benign prostatic hyperplasia

Occurred in men over 50 years of age, have difficulty urinating, urinary retention, severe cases caused by kidney, ureteric effusion, digital rectal examination, cystoscopy, cystography can be clearly diagnosed.

2. Bladder neck obstruction

Women have difficulty urinating and retaining urine, the skin around the anus and the perineum feel normal, and cystoscopy or urodynamic examination can identify.

3. Congenital urethral valve

More common in children, dysuria, urinary retention, urethroscopy or urethrography can be identified.

4. Female stress urinary incontinence

The detrusor function was normal, the urethral resistance was reduced, and the bladder neck elevation test was positive. The bladder urethrography showed that the posterior angle of the bladder and urethra disappeared and the position of the bladder neck decreased.

5. Urethral stricture

It can be congenital or acquired, with dysuria as the main manifestation, urethral probe examination has obvious narrow sections, and urethral angiography can clearly diagnose.

6. Bladder neck obstruction

Difficulty of urination is often accompanied by painful urination. Urinary flow interruption can occur suddenly during urination. Ultrasound can show strong echoes, opaque shadows can be seen on plain film of bladder area, and cystoscopy can determine the size and number of stones.

7. Bladder cancer

A pedicated tumor located near the bladder neck and triangle can cause dysuria, urinary retention and other symptoms due to blockage of the urethral orifice. However, patients usually have intermittent painless hematuria. Examination of urine exfoliated cells can detect cancer cells, and bladder can be seen in IVU Filling defect in the area, cystoscopy can directly determine the location, size, and number of tumors, and biopsies can be taken at the same time.

Neurogenic bladder complications

Urinary tract infection is the most common complication of neurogenic bladder. Urinary calculi can occur in 10% to 15% of patients, and the incidence of bladder ureteral reflux in neurogenic bladder is 10% to 40%, usually reversible. When the urination situation is improved, the remaining urine is reduced, and the bladder pressure is reduced, there may be an improvement on its own. It may also be complicated by pyelonephritis, renal failure, hydronephrosis and so on.

Neurogenic Bladder Treatment

The treatment of neurogenic bladder is mainly to protect the upper urinary tract function, prevent chronic renal failure caused by pyelonephritis and hydronephrosis; the second is to improve the symptoms of dysuria to reduce the suffering of patients. The specific measures for treatment are to reduce the residual urine volume by various non-surgical or surgical methods. After the residual urine volume is eliminated or reduced to a small amount (<50mL), urinary tract complications can be reduced.

Non-surgical treatment

(1) Regardless of the purpose of urinary catheterization to promote storage or urination, intermittent catheterization can effectively treat neuromuscular voiding dysfunction, avoid the pain of long-term urethral catheterization and even suprapubic bladder fistula. Treatment (bladder enlargement, controlled urinary diversion) creates the conditions.

(2) Adjuvant treatment Empty the bladder regularly; Pelvic floor muscle training; Train "trigger points" to urinate; Males use external urine collection devices.

(3) Drug therapy Drugs for treating detrusor overactivity, such as M blockers. Drugs for the treatment of detrusor weakness, M receptor agonists. drugs that reduce the resistance of the bladder outlet, such as alpha blockers. Drugs that increase resistance to bladder exit: alpha receptor agonists. Drugs that reduce urine production, such as desmopressin. Other drugs.

(4) Acupuncture therapy Acupuncture has a good effect on diabetic sensory paralysis bladder, especially for early lesions.

(5) Closed therapy This method is suitable for upper motor neuron disease (super detrusor hyperreflexia). After closure, the effect is good, the residual urine volume is significantly reduced, and the symptoms of dysuria are significantly improved. In a few patients, the effect can be maintained for several months to one year after being closed once. These patients only need to be closed on a regular basis without surgery.

(6) Bladder training and dilatation are severe for frequent urination and urgency, and those with no residual urine or small residual volume can be treated with this method. Instruct patients to drink water regularly during the day, 200mL per hour. Extend the interval of urination to make the bladder easy to gradually expand.

2. Surgical treatment

Its role is to improve bladder compliance and volume, and change bladder outlet resistance. It needs to be proved to be ineffective by non-surgical treatment and should be performed after the neuropathy is stable. Patients with mechanical obstruction of the lower urinary tract should consider removing obstruction factors first.

Surgical methods are divided into four categories: surgical procedures for treating dysfunction of urine storage, surgical procedures for dysfunction of urination, surgical procedures for simultaneously treating urine storage and dysuria, and diversion of urinary flow.