neurogenic bladder

1. NEUROGENIC
BLADDER
Chapter X

2. OBJECTIVES
On completion of this chapter, the learner will
be able to:
 Assess and care for a patient with renal
diseases
 Analyze how to prevent complication and
educate a patient with renal problem
 Initiate education and preparation for patients
undergoing assessment of the urinary
2

3. NEUROGENIC BLADDER
 Neurogenic bladder refers to dysfunction of
the urinary bladder due to disease of the
central nervous system or peripheral nerves
involved in the control of micturition.

4. CAUSES
 Neurogenic bladder is often associated with
spinal cord diseases, injuries, and neural
tube defects including spina bifida.
 It may also be caused by brain tumors and
other diseases of the brain, and by
peripheral nerve diseases.
 It is a common complication of major
surgery in the pelvis, such as for removal of
sacrococcygeal teratoma and other tumors.

5. ASSESSMENT AND DIAGNOSTIC
FINDINGS
 Measurement of fluid intake, urine output,
and residual urine volume, urinanalysis.
 Assessment of sensory awareness of bladder
fullness and degree of motor control.
 Comprehensive urodynamic studies are also
performed.

6. COMPLICATIONS
 Infection resulting from urinary stasis and
cauterization.
 Long term complications include:
1. Urolithiasis
2. Vesicoureteral flux
3. Hydronephrosis
4. Destruction of the kidney.

7. CANCER OF THE BLADDER

8. CANCER OF THE BLADDER
 Cancer of the bladder is the second most
common urologic malignancy. Approximately
90% of all bladder cancers are transitional
cell carcinomas, which arise from the
epithelial lining of the urinary tract;
transitional cell tumors can also occur in the
ureters, renal pelvis, and urethra. The
remaining 10% of bladder cancers are
adenocarcinoma, squamous cell carcinoma,
or sarcoma.

9. CLINICAL MANIFESTATIONS
 Painless hematuria, either gross or
microscopic most characteristic sign
 Dysuria, frequency, urgency ,bladder
irritability
 Pelvic or flank pain obstruction or distant
metastases
 Leg edema from invasion of pelvic lymph
nodes

10. COMPLICATIONS
 Regional metastasis through the pelvis as
well as metastasis to the lung, liver, and
bone

11. NURSING ASSESSMENT
 Assess for hematuria, irritative voiding
symptoms, risk factors (especially smoking
history), weight loss, fatigue, and signs of
metastasis.
 Assess coping ability and knowledge of the
disease.

12. NURSING DIAGNOSES
 Impaired Urinary Elimination related to
hematuria and transurethral surgery
 Acute Pain related to irritative voiding
symptoms and catheter-related discomfort
 Anxiety related to diagnosis of cancer

13. NURSING INTERVENTIONS
Maintaining Urinary Elimination After
Transurethral Surgery
 Maintain patency of indwelling urinary
drainage catheter; manual irrigation is not
recommended due to dangers of bladder
perforation; continuous bladder irrigation may
be used if necessary.
 Ensure adequate hydration either orally or I.V.
 Monitor intake and output, including irrigation
solution.
 Monitor urine output for clearing of hematuria.

14. NURSING INTERVENTIONS
Controlling Pain
 Administer analgesic medication for pelvic
discomfort.
 Administer anticholinergic medications or
belladonna and opium suppositories to
relieve bladder spasms.
 Ensure patency of catheter drainage; do not
irrigate unless specifically ordered.
 Remove indwelling catheter as soon as
possible after procedure.

15. NURSING INTERVENTIONS
Relieving Anxiety
 Allow patient to verbalize fears and
concerns.
 Provide realistic information about diagnostic
studies, surgery, and treatments.

16. PATIENT EDUCATION AND HEALTH MAINTENANCE
 Advise patient that irritative voiding symptoms
and intermittent hematuria are possible for
several weeks after transurethral resection of
bladder tumors.
 Teach patient importance of vigilant adherence
to follow-up schedule: cystoscopy every 3
months for 1 year, then every 6 months to 1
year thereafter for the rest of patient's life
(70% of superficial tumors will recur).
 Review purpose and adverse effects of
intravesical chemotherapy treatments (usually
not given until after recurrence).

17. EVALUATION: EXPECTED OUTCOMES
 Urine output adequate and clear
 Verbalizes relief of pain and bladder spasms
 Verbalizes lessened anxiety