Neurogenic Bladder: Epidemiology, Diagnosis, and Management

Semin Neurol, 2020 · DOI: https://doi.org/10.1055/s-0040-1713876 · Published: October 16, 2020

Simple Explanation

Neurogenic bladder refers to lower urinary tract dysfunction caused by neurological disease. This dysfunction significantly impacts the quality of life of those affected, and neurologists are increasingly recognizing its importance. The symptoms vary depending on the location of the neurological damage. The bladder and urethral sphincter functions are maintained by a complex neural network. This network allows for low-pressure filling and periodic voluntary emptying of the bladder. The decision to switch from storage to voiding is a conscious one influenced by bladder fullness and social appropriateness. Managing neurogenic bladder involves a multidisciplinary approach that includes neurologists, urologists, and other healthcare professionals. The goals of management are to achieve urinary continence, improve quality of life, prevent UTIs, and preserve upper urinary tract function.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review Article

Key Findings

1
Detrusor overactivity is the most common cause of urinary incontinence following neurological disease. Damage to central inhibitory pathways or sensitization of peripheral afferent terminals in the bladder can cause spontaneous involuntary contractions of the detrusor.
2
In Parkinson's disease, LUT symptoms are the most common non-motor symptoms and are associated with increased risk for falls, early institutionalization, and escalating health-related costs. Nocturia is the most common LUT symptom.
3
Patients with SCI or spina bifida are at significant risk of developing upper urinary tract damage, having a five or eight times risk, respectively, of developing renal failure compared with the general adult population.

Research Summary

Neurogenic bladder, or lower urinary tract (LUT) dysfunction caused by neurological disease, significantly impacts quality of life. The location and nature of the neurological lesion influence the pattern of dysfunction. Initial evaluation involves history taking, a bladder diary, and potentially uroflowmetry, post-void residual measurement, and other tests depending on the clinical scenario. Incomplete bladder emptying is often managed with intermittent catheterization, while storage dysfunction is managed with antimuscarinic medications. An individualized approach is essential for managing LUT dysfunction in this specific population. This includes addressing both storage and voiding dysfunction, and is influenced by the severity of symptoms and risk for developing upper urinary tract damage.

Practical Implications

Personalized Treatment Plans

The need for individualized, patient-tailored approaches to managing lower urinary tract dysfunction in neurological patients.

Early Detection and Monitoring

Recognizing the importance of early detection and regular monitoring to prevent upper urinary tract damage, especially in high-risk populations.

Multidisciplinary Collaboration

The importance of collaboration between neurologists, urologists, and other specialists to improve patient outcomes.

Study Limitations

1
Lack of long-term natural history studies to guide follow-up frequency.
2
Data on the effectiveness of specific treatments for neurogenic bladder in conditions other than SCI and MS are scarce.
3
The decision to perform complete baseline urodynamic studies depends on local recommendations and resources, highlighting a need for more standardized guidelines.

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