1. Neurogenic bladder is caused by damage to the nervous system that controls bladder function, resulting in the bladder being unable to empty completely or contract properly. 2. It is diagnosed through medical history, exams, bladder function tests and imaging to evaluate the bladder and kidneys. 3. Treatment includes physical therapy like timed voiding, electrical stimulation implants, catheterization, and sometimes surgery to address the bladder sphincter or install an artificial sphincter. Follow-up care monitors bladder and kidney health.

1. DEPARTMENT OF UROLOGY EDUCATION
Production Team
Dr Abraham Benjamin - Manager Medical Informatics
Mr. Naresh Kumar - Coordinator Medical Informatics
Neurogenic Bladder

2. What is Neurogenic Bladder?
 Neurogenic bladder is the loss of normal
bladder function caused by damage to part
of the nervous system.
 The damage can cause the bladder to be
underactive, in which it is unable to contract
and unable to empty completely.

3. Anatomy of the Urinary Bladder

4. What happens in normal conditions ?
 The muscles and nerves of the urinary system must function in
a coordinated fashion with the bladder in order to perform its
two major functions of storage and elimination of urine.
 Nerves carry messages from the bladder to the brain and then
from the brain to the muscles of the bladder telling them to
tighten or release, allowing the bladder to empty during
urination.

5. What are some risk factors for neurogenic bladder ?
 Risk factors for neurogenic bladder include various
birth defects, which adversely affect the spinal cord
and function of the bladder, like spina bifida.
 Tumors within the spinal cord.
 Traumatic spinal cord injury is also a major risk
factor for development of neurogenic bladder.

6. What are the symptoms of Neurogenic Bladder ?
 Inability to control urination, also known as urinary
incontinence is associated with the neurogenic bladder. This
may be caused by abnormalities in bladder capacity or
malfunction of control mechanisms such as the bladder neck
and external urethral sphincter muscle that are important for
the bladder's storage function.
 Symptoms including a dribbling urinary stream, straining
during urination or inability to urinate may also be associated
with neurogenic bladder.

7. What are the symptoms of Neurogenic Bladder ?
 Urinary retention.
 Increased bladder pressures from neurogenic bladders can be caused by the
inability of the bladder muscle to relax properly and expand to store urine.
 Stones may also form in the urinary tract of individuals with a neurogenic
bladder caused by the stoppage of urine flow .
 Abnormal backup of urine from the bladder to the kidney, also known as
vesicoureteral reflux(VUR), may develop as a means of releasing high
pressure within the bladder.
 A Urinary Tract Infection is of particular concern as Vesico Ureteral Reflux
may place the patient at significant risk for a severe kidney infection by
transporting infected bladder urine directly to the kidneys.

8. How is Neurogenic Bladder Diagnosed ?
 Complete medical history and physical examination is done
 Bladder function tests including Urodynamic evaluations,
which has two components CMG (Cystometrogram) which
measures bladder function, capacity, compliance and
voiding and storage pressures. Along with EMG
(Electromypography) which help measure urethral
sphincter tone and bladder coordination.
 Imaging tests of the bladder and kidneys are performed.

9. How is Neurogenic Bladder Treated ?
 The main goal of Urologic management is to prevent
damage to the upper tracts (kidneys). The secondary
goal is minimize any disabilities.
 Treatment for neurogenic bladder fall the following
categories: physical-psychological, electrical-
stimulatory, and surgery.

10. How is Neurogenic Bladder Treated ?
 Physical-psychological therapy
 Physical-psychological therapy, is also called timed voiding, It
combines willpower and exercise.
 The patient is asked to keep a voiding diary, which is a daily record of the
amount and time of fluid intake, times of urination, and episodes of
leakage. The record creates a pattern that may initially allow patients to
determine the times of the day they should be in close proximity to a
bathroom.
 These are also the times when a patient should attempt to urinate. The
intervals between voiding times are gradually extended as the patient
gains control over voiding. This conditioning is often coupled with physical
exercises, principally Kegel exercises, which strengthen pelvic muscles. The
Valsalva maneuver, an exertion used to pass stool, may also be sufficient
to empty a bladder.

11. How is Neurogenic Bladder Treated ?
Electrical-stimulatory therapy
Electrical-stimulatory therapy is a recent advance.
Electrodes and a small stimulator are implanted
in a minor surgical procedure. The electrodes are
placed near targeted nerves. The stimulator is
placed beneath the skin. The stimulator delivers
electrical impulses that mimic those that would
normally be delivered by nerves if they were
undamaged.

12. How is Neurogenic Bladder Treated ?
 Surgery
 Intermittent self Catheterization is frequently employed to ensure complete
bladder drainage. It involves the insertion of a thin tube through the urethra and
into the bladder. A number of patients can learn to insert the catheter themselves.
The therapy is called Clean Intermittent Catheterization (CIC).
 Urethral stents, something like an internal catheter, can be surgically inserted
through the sphincter muscle to expand it and allow urine to be drained.
 The sphincter can be surgically weakened by a procedure called sphincter
resection, which removes a portion of the muscle or the muscle may be removed
in its entirety in a sphincterotomy.
 Artificial sphincters are a mechanical intervention. These devices consist of a cuff
that fits around the bladder neck, a pressure regulating balloon and a pump that
inflates the cuff. The balloon is placed beneath the abdominal muscles. The pump
is placed in the labia in women and in the scrotum for men.

13. What can be expected after the treatment of
Neurogenic Bladder ?
A patient can expect extensive follow-up
evaluation of bladder and kidney function.
This may involve repeated X-rays, ultrasound,
blood tests and bladder function tests.
Most issues in neurogenic bladder typically
require constant attention and reevaluation.

14. Important Information
 If you need more details about this
condition or meet our team of
Urologists for Consultation click on the
link below.
 http://www.ramayyapramila.com/

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