OVERVIEW

What is neurogenic bladder?

Neurogenic bladder refers to a series of lower urinary tract symptoms caused by neurological lesions affecting the structures controlling urination, such as the bladder and urethra. These symptoms include frequent urination, urgency, incontinence, difficulty urinating, urinary retention, and post-void dribbling.

The presence of neurological damage is a prerequisite for diagnosis, and different neurological lesions manifest with varying clinical symptoms.

Neurogenic bladder can severely impact a patient's quality of life, causing significant distress. Additionally, it may lead to serious upper urinary tract complications, such as kidney failure. Active personalized treatment and close follow-up are fundamental strategies for managing this condition.

Is neurogenic bladder common?

Currently, there are no precise statistics on the prevalence of neurogenic bladder in the general population, but such cases are relatively common in clinical practice, particularly among patients with diabetes or cerebrovascular accidents. Almost all neurogenic bladder patients exhibit varying degrees of neurological dysfunction.

What are the types of neurogenic bladder?

There is no unified classification system for neurogenic bladder. Given the diverse and complex causes and clinical manifestations, it is generally referred to simply as neurogenic bladder.

SYMPTOMS

What are the common symptoms and manifestations of neurogenic bladder?

• Urogenital symptoms:

  • Neurogenic bladder primarily presents as lower urinary tract symptoms, including storage symptoms such as urinary frequency, urgency, nocturia, incontinence, and enuresis; voiding symptoms such as dysuria, hesitancy, urinary retention, and painful urination; and post-void symptoms such as dribbling and incomplete emptying.

  • Abnormal bladder sensation, such as unusual bladder fullness or urgency.

  • Sexual dysfunction symptoms, including erectile dysfunction, abnormal orgasm, ejaculation disorders, decreased libido, and dyspareunia.

  • Lower back pain, pelvic pain, hematuria, and pyuria.

• Bowel symptoms: Frequent bowel movements, constipation, fecal incontinence, abnormal rectal sensation, tenesmus, and altered bowel habits.

• Neurological symptoms: Limb sensory or motor dysfunction, muscle spasms, autonomic hyperreflexia, psychiatric symptoms, and cognitive decline.

• Other symptoms: Fever, elevated blood pressure, and other autonomic dysfunction manifestations.

What severe complications can neurogenic bladder cause?

• Neurogenic bladder may lead to vesicoureteral reflux, causing hydroureteronephrosis. In severe cases, it can result in renal failure, uremia, or even death.

• It can also cause urinary tract infections (UTIs). Recurrent UTIs may lead to renal impairment, reduced life expectancy, and increased mortality.

• Additionally, neurogenic bladder is often associated with sexual dysfunction, which may contribute to infertility in some patients.

CAUSES

What are the common causes of neurogenic bladder?

• Central nervous system diseases: Cerebrovascular accidents, brain tumors, normal pressure hydrocephalus, cerebral palsy, intellectual disability, dementia, Parkinson's disease, multiple system atrophy, ataxia, multiple sclerosis, traumatic spinal cord injury, spinal dysraphism, tethered cord syndrome, spinal tumors, hereditary spastic paraplegia, cauda equina syndrome, lumbar disc herniation, spinal stenosis, cervical spondylosis, etc.

• Peripheral nervous system diseases: Diabetes, alcoholism, drug abuse, porphyria, sarcoidosis, etc.

• Infectious diseases: AIDS, acute infectious polyradiculoneuritis, herpes zoster, human T-lymphotropic virus infection, Lyme disease, poliomyelitis, syphilis, tuberculosis, etc.

• Iatrogenic factors: Spinal surgery, radical resection of rectal cancer, radical hysterectomy, radical prostatectomy, regional spinal anesthesia, etc.

• Other causes: Hinman syndrome, myasthenia gravis, systemic lupus erythematosus, familial amyloid polyneuropathy, etc.

What are the common high-risk groups for neurogenic bladder?

• Individuals with hereditary or congenital diseases, such as spina bifida, myelomeningocele, and other developmental abnormalities;

• Long-term diabetic patients;

• Patients with herpes zoster, Guillain-Barré syndrome, multiple sclerosis, dementia, Parkinson's disease, cerebrovascular accidents, intracranial tumors, spinal cord tumors, lumbar disc herniation;

• Patients with spinal cord injuries;

• Drug abusers or alcoholics;

• Patients who have undergone pelvic surgery.

DIAGNOSIS

What tests are needed to diagnose neurogenic bladder?

• Detailed physical examination, including urogenital and neurological examinations;

• Urinalysis, renal function tests, urine culture, etc.;

• Urinary system ultrasound, urinary system plain film, intravenous urography, urinary system CT, urinary system MR hydrography, renogram, cystourethrography, etc.;

• Cystourethroscopy;

• Urodynamic studies;

• Neuroelectrophysiological tests.

The diagnosis of neurogenic bladder is complex. Patients are advised to seek medical attention at a reputable hospital promptly. Doctors will select appropriate tests based on the specific condition.

Why are these tests necessary for diagnosing neurogenic bladder? What are their purposes?

• Physical examination: Assesses the patient's mental state, consciousness, intelligence, and motor function to preliminarily evaluate for urogenital or neurological abnormalities.

• Urinalysis, renal function tests, urine culture, renogram: Evaluates for urinary tract infections or renal dysfunction.

• Urinary system ultrasound: Checks for hydronephrosis, hydroureter, other urinary diseases, or residual urine.

• Urinary system plain film: Assesses for occult spina bifida, lumbosacral developmental anomalies, or concurrent stones.

• Intravenous urography, urinary system CT, urinary system MR hydrography, cystourethrography: Examines morphological changes in the urinary system, grades upper urinary tract dilation, and excludes other urinary diseases.

• Cystourethroscopy: Directly visualizes bladder and urethral anatomy.

• Urodynamic studies: Objectively evaluates lower urinary tract function and plays an irreplaceable role in the diagnosis and follow-up of neurogenic bladder.

• Neuroelectrophysiological tests: Assesses sensory and motor nerve pathways of the lower urinary tract and pelvic floor for abnormalities.

What precautions should be taken for urodynamic studies in neurogenic bladder diagnosis?

Before urodynamic studies, patients should empty their bowels. If necessary, an enema may be performed the night before. If treatment allows, medications affecting the lower urinary tract should be discontinued 48 hours prior.

If medication cannot be stopped, inform the doctor about current medications during the test for more accurate result analysis.

What diseases are easily confused with neurogenic bladder?

Neurogenic bladder can be easily confused with urinary tract infections or benign prostatic hyperplasia.

Diagnosis of neurogenic bladder is complex. Patients should seek timely medical attention at a reputable hospital for accurate diagnosis and avoid self-diagnosis or self-medication.

TREATMENT

Which department should I visit for neurogenic bladder?

Urology, Nephrology, Endocrinology, etc.

How is neurogenic bladder treated?

• Conservative treatment: Minimally invasive, cost-effective, and practical, with few severe adverse effects when applied correctly. It can effectively delay the progression of neurogenic bladder and improve patients' quality of life. Conservative treatment should be maintained throughout the entire treatment process for neurogenic bladder patients. Methods include: assisted manual voiding, bladder behavior training, pelvic floor muscle exercises, pelvic floor biofeedback, intermittent catheterization, indwelling catheterization, cystostomy, external urine collection devices, intravesical drug instillation therapy, and electrical stimulation therapy.

• Oral medication: Single-drug therapy has limited efficacy for neurogenic bladder. Combined treatments, including medication, are required for optimal results.

• Surgical treatment: Includes procedures to address storage dysfunction, voiding dysfunction, combined storage and voiding dysfunction, and urinary diversion. Patients should understand that the primary goal of surgery is to protect upper urinary tract function, not merely to improve continence or voiding ability.

Neurogenic bladder varies in type and is complex to diagnose. Treatment should be personalized. Patients are advised to seek timely medical attention at a reputable hospital for an accurate diagnosis and appropriate treatment plan based on their specific condition.

What medications are used to treat neurogenic bladder? What are their common side effects?

• Drugs for detrusor overactivity: M-receptor antagonists (e.g., tolterodine, solifenacin) are generally well-tolerated, with common side effects like dry mouth and constipation. Phosphodiesterase inhibitors (e.g., sildenafil, tadalafil) are also well-tolerated, with side effects such as headache and flushing.

• Drugs to reduce bladder outlet resistance: Alpha-blockers (e.g., tamsulosin, alfuzosin, terazosin) may cause orthostatic hypotension.

• Drugs to reduce urine production: Desmopressin may cause headaches and nausea.

What are the common surgical procedures for neurogenic bladder? What are their complications?

• Botulinum toxin A bladder wall injection: Rare adverse effects, with the most common complications being lower urinary tract infections and urinary retention.

• Autologous bladder augmentation: Common complications include bladder perforation and mucosal ischemia fibrosis.

• Enterocystoplasty: Common complications include mucus obstruction, urinary tract infections, stone formation, and electrolyte imbalances.

• Urethral sling surgery: Complications may include sling breakage/loosening, urethral erosion due to excessive pressure, infection, and dysuria.

• Sacral posterior rhizotomy + anterior sacral root stimulation: Complications may include erectile/ejaculatory dysfunction, aggravated constipation, device failure, infection, and pain.

Does neurogenic bladder require follow-up? How is it monitored?

Yes, follow-up is necessary.

Neurogenic bladder is an unstable condition that can change rapidly, requiring long-term, regular follow-up.

Follow-up allows doctors to assess bladder-urethral function and detect complications, adjusting treatment as needed.

Follow-up includes urinalysis (every two months), urinary tract ultrasound (every six months), renal function tests, and urodynamic studies (annually). Frequency may vary based on condition changes.

Can neurogenic bladder be cured?

It is difficult to cure.

Since neurogenic bladder is caused by nerve damage—and most nerve damage cannot yet be fully repaired—symptoms can be managed but rarely cured.

Can neurogenic bladder recur?

Yes, it can recur.

Neurogenic bladder is an unstable condition that may fluctuate in severity, requiring long-term follow-up.

DIET & LIFESTYLE

What should be noted in daily life for neurogenic bladder?

• Learn proper manual-assisted urination techniques and maintain a regular urination schedule;

• Persist with rehabilitation exercises, such as bladder behavior training and pelvic floor muscle exercises;

• Strengthen local perineal care;

• Keep a consistent record of a voiding diary;

• Strictly follow medical advice, take medications on time and in the prescribed dosage, avoid self-discontinuation, and attend regular follow-up examinations;

• For patients with frequent urination, nocturia, or urinary incontinence, fluid intake may be appropriately reduced.

Does neurogenic bladder affect fertility?

Yes, it affects fertility.

Neurogenic bladder is often accompanied by sexual dysfunction, such as erectile dysfunction, ejaculation disorders, reduced semen quality, dyspareunia, and decreased libido, all of which can impact fertility and ultimately lead to infertility.

PREVENTION

Can Neurogenic Bladder Be Prevented? How to Prevent Neurogenic Bladder?

It is difficult to prevent.

Since neurogenic bladder is caused by neurological damage, prevention at the root cause is challenging. However, further progression of the condition can be mitigated.

Early diagnosis, standardized treatment, and regular follow-ups can effectively prevent the worsening of lower urinary tract symptoms and even avoid the onset of kidney failure.