The term “neurogenic bladder” encompasses a variety of clinical and urodynamic entities. In general, it refers to clinical problems related to bladder dysfunction secondary to underlying neurological conditions. It is important to obtain a thorough clinical history followed by examination including a good neurological assessment. While this may give clues to the underlying problem, correct management will not be achieved without the aid of laboratory testing, imaging, and urodynamic evaluation, the last in many patients playing a key role in their management. While certain conditions may warrant specific treatments, management, in general, becomes easy once patients are classified based on their urodynamic pattern. The key determinant in the management of neuro-urological problems is to ascertain whether the bladder is “safe” or “unsafe,” i.e., its impact on the renal function. Once this has been determined, management of these entities becomes easy. It is worth remembering that the bladder is a dynamic organ and tends to change physiologically and hence functionally over time. In this chapter, key concepts in identification and management of common clinical entities that cause “neurogenic bladder” will be discussed.
KeywordsStress Urinary Incontinence Botulinum Toxin Pelvic Organ Prolapse Neurogenic Bladder Urethral Sphincter
I am grateful to Prof. Chris Chapple, Consultant Urological Surgeon, Sheffield Teaching Hospitals, and Honorary Professor, Sheffield Hallam University, UK, for his review of the manuscript.
- 3.Haylen B, Ridder D, Freeman R, Steven S, Berghmans B, et al. An International Urogynaecological Association (IUGA), International Continence Society (ICS) joint report on the terminology of pelvic floor dysfunction. NeurourolUrodyn. 2010;29:4–20.Google Scholar
- 12.Mangera A, Andersson K-EE, Apostolidis A, Chapple C, Dasgupta P, Giannantoni A, Gravas S, Madersbacher S. Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA). Eur Urol. 2011;60:784–95.PubMedCrossRefGoogle Scholar
- 14.Chartier-Kastler E, Denys P. Intermittent catheterization with hydrophilic catheters as a treatment of chronic neurogenic urinary retention. NeurourolUrodyn. 2011;30:21–31.Google Scholar
- 15.Wein AJ. Lower urinary tract dysfunction in neurologic injury and disease. In: Wein AJ et al., editors. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders; 2007.Google Scholar
- 18.Peters K, Gilmer H, Feber K, Girdler B, Nantau W, Trock G, Killinger K, Boura J. US pilot study of lumbar to sacral nerve rerouting to restore voiding and bowel function in spina bifida: 3-year experience. Adv Urol. 2014;17 Article ID 863209, 7 pages. doi: 10.1155/2014/863209.