What is Neurogenic Bladder?
Neurogenic bladder (also called neurogenic lower urinary tract dysfunction or NLUTD) is abnormal function of the bladder, bladder neck, and/or sphincters caused by an underlying neurologic disorder. 1, 2
Core Definition and Scope
The term "neurogenic bladder" has been largely replaced by the more accurate term "neurogenic lower urinary tract dysfunction" (NLUTD) because the dysfunction extends beyond just the bladder itself to include the bladder neck and sphincters. 1 This condition always has an underlying neurological disorder as its cause—it is not simply bladder dysfunction, but rather a manifestation of nervous system pathology. 2
Clinical Manifestations
Patients with NLUTD present with a constellation of lower urinary tract symptoms including: 1, 2
- Urinary incontinence (both urgency incontinence and overflow incontinence)
- Urinary retention with incomplete bladder emptying
- Recurrent urinary tract infections (UTIs)
- Autonomic dysreflexia (in patients with spinal cord injuries above T6)
- Urgency and frequency of urination 3
- Urinary leakage and dysuria 3
Common Underlying Neurological Causes
The neurological disorders that cause NLUTD include: 2, 4, 5
- Spinal cord injury (nearly all patients develop some degree of bladder dysfunction)
- Spina bifida/myelomeningocele (approximately 26% develop renal failure)
- Multiple sclerosis
- Cerebrovascular accidents (stroke)
- Parkinson's disease
- Diabetes mellitus (via peripheral neuropathy)
- Chronic alcohol use (via neuropathy)
- AIDS-related neurological complications
Pathophysiology
The bladder's normal function depends on intact neural pathways between the pontine micturition center (in the brainstem), the sacral micturition center (Onuf's nucleus at S2-S4), and the bladder itself. 6 Damage anywhere along this pathway—whether in the brain, spinal cord, or peripheral nerves—disrupts the coordinated storage and emptying functions of the bladder. 4, 7 The specific pattern of dysfunction depends on the location and extent of the neurological lesion. 6
Critical Clinical Implications
The primary goal of managing NLUTD is preservation of renal function and achievement of social continence. 4 Without proper treatment, NLUTD can lead to: 8, 5
- Upper urinary tract damage from high bladder pressures
- Hydronephrosis and vesicoureteral reflux
- Recurrent infections leading to nephropathy
- Progressive renal failure
- Bladder stones
- Increased risk of bladder cancer (gross hematuria occurs in 32% of bladder cancer cases in NLUTD patients) 1
Diagnostic Approach
Comprehensive neurological assessment and urodynamic studies are essential for accurate diagnosis. 2 However, risk stratification should only be performed once the neurological condition has stabilized—not during acute spinal shock (which can last 3-6 months or up to 1-2 years) or immediately after acute brain injury. 1 There is poor correlation between clinical symptoms or somatic neurologic signs and actual urodynamic findings, making objective testing crucial. 4
Common Pitfall
A critical pitfall is assuming that initial evaluation predicts long-term dysfunction. 2 Risk stratification must be repeated when patients experience new or worsening symptoms, as the pattern of dysfunction can change considerably over time. 1 Regular monitoring is essential even in asymptomatic patients with relevant neurological conditions. 2