NEUROGENIC BLADDER

Nurfathanah H1A 006 033

Introduction

The normal function of the urinary bladder is to store and expel urine in a coordinated, controlled fashion. This coordinated activity is regulated by the central and peripheral nervous systems.

Physiology

Neurogenic Bladder

A neurogenic bladder is any type of bladder or lower urinary tract dysfunction related specifically to a neurologic disease. Any conditions that disrupt the nervous pathways from the brain to the spinal cord and to the peripheral nerves that supply the bladder can lead to a neurogenic bladder.

Types of Neurogenic Bladders

Supraspinal lesions They include cerebrovascular accident, brain tumor, Parkinson disease, and Shy-Drager syndrome. Spinal cord lesions
Spinal cord injury Spinal cord lesions Multiple sclerosis

Peripheral nerve lesions Peripheral nerve lesions due to diabetes mellitus, tabes dorsalis, herpes zoster, herniated lumbar disk disease, and radical pelvic surgery result in detrusor areflexia.

Sign and Simptom

Failure to Empty Failure to Store

Failure to Empty

The feeling of fullness and difficulty emptying their bladder. Nocturia. Urinary incontinence. Urinary tract infections and bladder stones. Loss of bladder sensation.

Failure to Store

Urgency Frequency Incontinence

Diagnosis

USG Cystoscopy IVP

Treatment
Failure to empty:

Decrease outlet resistance Intermittent catheterization program Injecting botulinum toxin (Botox) into the sphincter Indwelling catheters are a last resort Surgery to open up the sphincter (sphincterotomy)

Cont
Failure to store :

Behavioural modifications like altering diet, reducing fluid intake and stimulants in their diet. Review medications especially diuretics medications Timed voiding or bladder retraining Medications (anticholinergics) Botulinum toxin (Botox bladder injection) Sacral neuromodulation (bladder pacemaker) Major surgery

Thank you