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Neurogenic bladder
Last reviewed: 07.07.2025
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[ Epidemiology
Urination disorders due to neurogenic bladder are often encountered in the clinical practice of neurologists, urologists, neurosurgeons and doctors of other specialties. It is known that urination disorders are found in 38-70% of patients with Parkinson's disease. In 50-90% of patients with multiple sclerosis, as well as in all patients with Shy-Drager syndrome. It also occurs in 6-18% of patients with intervertebral disc diseases, in 50% with spina bifida and in almost 100% of patients with spinal injuries.
These data indicate a high prevalence of neurogenic bladder in neurological patients. The absence or inadequate treatment of neurogenic urination disorders often leads to chronic renal failure and even death of the patient. It is known that one of the most common causes of death in neurological patients (after respiratory complications) is azotemic intoxication and purulent-inflammatory diseases of the upper urinary tract and lower urinary tract.
Symptoms neurogenic bladder
Neurogenic bladder has symptoms that are mainly represented by characteristic signs of accumulation: urgent (imperative) and frequent urination during the day and night, as well as urgent urinary incontinence. These symptoms are characteristic of neurogenic detrusor overactivity.
Bladder emptying symptoms include a thin weak stream of urine, the need for abdominal pressure during urination, intermittent urination, and a feeling of incomplete bladder emptying. They occur with decreased detrusor contractility and inadequate relaxation of the striated sphincter of the urethra.
Forms
Any damage to the nervous system between the cerebral cortex and the urinary bladder with sphincters can cause dysfunction of the lower urinary tract. The type of disorder depends largely on the level and extent of the damage to the nervous system. The International Continence Society recommends using the functional classification of neurogenic lower urinary tract dysfunction proposed by Madersbacher in 2002.
In this classification, the disorder of the act of urination is considered from the point of view of the disorder of the function of filling or emptying the bladder, taking into account the behavior of its sphincters, and the characteristics of the state of the bladder and the striated sphincter of the urethra are given depending on the level of damage.
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Treatment neurogenic bladder
Neurogenic bladder is treated to achieve preservation of renal function, creation of conditions for adequate bladder emptying or urine continence, and improvement of quality of life.
In each specific case, an individual approach is important to determine the treatment tactics. The choice of treatment method depends on the type of dysfunction of the lower urinary tract, taking into account the function of the detrusor and sphincters of the bladder.
Impaired accumulation of urine in the bladder due to neurological diseases and injuries is expressed in neurogenic detrusor overactivity (one of the forms of overactive bladder).