What is neurogenic bladder?

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 specifically caused by an underlying neurologic disorder. 1

Core Definition and Terminology

The term "neurogenic bladder" has been largely replaced by "neurogenic lower urinary tract dysfunction" (NLUTD) because the dysfunction extends beyond just the bladder itself to include the bladder neck and sphincters. 1 However, both terms refer to the same condition: bladder dysfunction that always has a neurological cause. 2

Clinical Manifestations

NLUTD presents with a spectrum of lower urinary tract symptoms including:

• Urinary incontinence (inability to hold urine) 1
• Urinary retention (inability to empty the bladder) 1
• Recurrent urinary tract infections 1, 3
• Autonomic dysreflexia (in certain neurological conditions) 1
• Obstructive uropathies 3

Common Neurological Causes

The most frequently encountered neurological disorders causing NLUTD include:

• Spinal cord injury - nearly all patients develop some degree of bladder dysfunction 2, 3
• Multiple sclerosis - one of the most common causes 2, 3
• Spina bifida (myelomeningocele) - approximately 26% develop renal failure if untreated 2
• Cerebrovascular accidents (stroke) 2
• Parkinson's disease 2
• Diabetes mellitus - causes peripheral neuropathy affecting bladder innervation 2
• Cerebral palsy 4
• Chronic alcohol use - may cause neuropathy affecting bladder function 2
• AIDS - can result in neurological complications affecting voiding 2

Pathophysiologic Patterns

NLUTD manifests in three distinct urodynamic patterns:

• Detrusor overactivity (most common at 48%) - the bladder contracts involuntarily 2
• Impaired contractility (30%) - the bladder cannot contract adequately to empty 2
• Poor compliance (15%) - the bladder becomes stiff and cannot store urine at safe pressures 2

In diabetic neurogenic bladder specifically, patients typically show impaired bladder sensation, increased bladder capacity, decreased detrusor contractility, and increased post-void residual volumes. 2

Critical Clinical Implications

The most important consequence of untreated NLUTD is upper urinary tract damage, including nephropathy and renal failure, which significantly impacts health and life expectancy. 3 This occurs when elevated bladder storage pressures are transmitted to the kidneys. 1

Patients with spina bifida face particularly high risk, with approximately 26% developing renal failure without proper management. 2

Diagnostic Requirements

Complete urodynamic testing is essential and should include:

• Cystometry (measures bladder pressure during filling) 2
• Uroflowmetry (measures urine flow rate) 2
• Pressure-flow studies (assesses voiding function) 2
• Sphincter electromyography (evaluates sphincter coordination) 2
• Electrophysiological testing for peripheral neuropathy assessment 2

Complex cystometrogram (CMG) is recommended during initial urological evaluation of patients with relevant neurological conditions, even without symptoms. 2 This proactive approach is critical because initial evaluation may not predict long-term dysfunction. 2

Key Clinical Pitfalls

Risk stratification must be repeated when patients experience new or worsening symptoms, as the initial evaluation cannot predict long-term dysfunction. 2 Regular monitoring is essential even in asymptomatic patients with relevant neurological conditions. 2

The condition requires ongoing neurological and urological assessment because it represents a manifestation of nervous system pathology that can evolve over time. 2