From the Guidelines
Neurogenic bladder urinary retention is primarily caused by spinal cord injuries, multiple sclerosis, diabetic neuropathy, and stroke, which disrupt normal communication between the brain and bladder, preventing proper bladder emptying. The most common causes of neurogenic bladder urinary retention include:
- Spinal cord injuries, which interrupt nerve signals traveling between the brain and bladder 1
- Multiple sclerosis, where demyelination affects nerve transmission 1
- Diabetic neuropathy, which damages peripheral nerves controlling bladder function 1
- Stroke, which can impair brain centers responsible for bladder control 1 Other significant causes include:
- Parkinson's disease, which affects autonomic nervous system function 1
- Spina bifida, a congenital defect affecting spinal nerve development 1
- Cauda equina syndrome, where compression of spinal nerve roots disrupts bladder innervation 1 Certain medications can also contribute to neurogenic bladder, particularly anticholinergics, antidepressants, and opioids 1. Pelvic surgeries may damage nerves supplying the bladder, while tumors can cause compression of neural pathways 1. Management of neurogenic bladder urinary retention typically involves catheterization (intermittent or indwelling), medications like alpha-blockers or cholinergics, and in some cases, surgical interventions such as sacral neuromodulation or urinary diversion procedures. Early diagnosis and treatment are essential to prevent complications like urinary tract infections, bladder damage, and kidney dysfunction 1.
From the FDA Drug Label
Oxybutynin chloride is indicated for the relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder (i.e., urgency, frequency, urinary leakage, urge incontinence, dysuria). The FDA drug label does not answer the question.
From the Research
Causes of Neurogenic Bladder Urinary Retention
The causes of neurogenic bladder urinary retention can be attributed to various factors, including:
- Spinal cord injury (SCI) 2, 3
- Spina bifida (SB) 2
- Cerebral palsy (CP) 2
- Multiple sclerosis (MS) 2, 4
- Diabetic neuropathy 5
- Alzheimer's disease 5
- White matter lesions 5
Pathophysiology
The pathophysiology of neurogenic bladder urinary retention involves the loss of supraspinal coordination and unabated reflexes in both autonomic and somatic nervous systems 3. This can lead to autonomic dysreflexia, dyssynergy between the urethral sphincters, and high pressures that can cause potential vesicoureteral reflux, urinary tract infections, and calculi associated with neurogenic lower urinary tract dysfunction (NLUTD) 3.
Management
The management of neurogenic bladder urinary retention includes:
- Intermittent catheterization (IC) with hydrophilic catheters 6
- Antimuscarinics for storage symptoms 4
- Intramuscular botulinum toxin A injections 4
- Tibial nerve stimulation 4
- Sacral neuromodulation 4
- Surgical procedures, such as catheterizable channels, bladder augmentation, and bladder outlet procedures 2