What is the definition of a neurogenic bladder in a patient with a neurological condition or disease?

Definition of Neurogenic Bladder

Neurogenic bladder is abnormal function of the bladder, bladder neck, and/or sphincters specifically caused by an underlying neurologic disorder, manifesting as urinary incontinence, retention, recurrent UTIs, and in some cases autonomic dysreflexia. 1, 2

Core Defining Features

The essential characteristic that distinguishes neurogenic bladder is its neurological etiology—there must always be an identifiable neurological disorder causing the bladder dysfunction 1. This differentiates it from other forms of bladder dysfunction that may be myogenic, idiopathic, or aging-related 1.

Clinical Manifestations

Neurogenic bladder encompasses a spectrum of dysfunction patterns 1:

• Detrusor overactivity (most common at 48% of cases) 1
• Impaired contractility (30% of cases) 1
• Poor compliance (15% of cases) 1

The symptoms include 1, 2:

• Urinary incontinence (both urge and overflow types)
• Urinary retention with elevated post-void residuals
• Recurrent urinary tract infections
• Autonomic dysreflexia in certain cases

Common Neurological Causes

The underlying neurological conditions include 1:

• 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 affecting bladder innervation)
• Chronic alcohol use (causing neuropathy)
• AIDS-related neurological complications

Diagnostic Requirements

The diagnosis requires 1, 2:

• Comprehensive neurological assessment to identify the underlying neurologic disorder
• Urodynamic studies including cystometry, uroflow, pressure/flow studies, and sphincter electromyography for definitive characterization
• Complex cystometrogram (CMG) recommended during initial evaluation of patients with relevant neurological conditions, even without symptoms

Critical Clinical Distinction

A key pitfall to avoid: neurogenic bladder is not simply any bladder dysfunction—it specifically requires demonstration of a causative neurological disorder 1, 2. The term "neurogenic lower urinary tract dysfunction (NLUTD)" is often used interchangeably and emphasizes that the dysfunction results from, rather than merely coexists with, the neurologic disorder 2.