11: Neurogenic Bladder
- Page ID
- 15639
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- 11.1: Introduction
- In a normal urogynecology practice, physicians might from time to time see patients with underlying neurologic diseases. These women may present to the clinic with symptoms of lower urinary tract dysfunction including incontinence, incomplete bladder emptying or recurrent bladder infections. It is important to have a basic knowledge of possible underlying neurological conditions that might cause these symptoms.
- 11.2: Physiology
- Normal voiding is a complex interaction of supraspinal and spinal control. This will cause relaxation of the urethra and sustained contraction of the detrusor to facilitate complete empting of the bladder.
- 11.3: Epidemiology
- There are no exact figures on the prevalence of neurologic disease of the lower urinary tract. It is important, however, to recognize that patients with neurological disease should be evaluated for lower urinary tract function.
- 11.4: Classification
- It is clear from the previous physiologic description that a simple classification is not possible. Therefore, the physician should evaluate detrusor and sphincteric function as separate entities. Both of these can be either normal, hyperactive or hypoactive in function. It is also important to make sure that there is co-ordination between the detrusor and sphincteric function.
- 11.5: Neurologic Conditions
- This is a brief summary of the neurological diseases that may encounter.
- 11.6: Clinical Evaluation
- The evaluation of the neurologic patient includes the normal physical, biochemical and dynamic testing that is important in all patients with lower urinary tract symptoms. The only difference is that special attention must be taken to include the state of the upper tract and neuromuscular evaluation. EMG measurements will give a better understanding of the exact lesion.
- 11.7: Treatment
- Treatments with different approaches.