Treatment of neurogenic bladder due to congenital disabilities in the closure of the spinal cord

Neurogenic bladder is bladder dysfunction (lethargy or spasticity) caused by neurogenic damage.

Possible symptoms: 

• urinary incontinence due to an overflow of the bladder;
• frequent urination;
• urgency to urinate;
• acute urinary incontinence and urinary retention.

The risk of serious complications is high (e.g., recurrent infection, vesicoureteral reflux, autonomic dysreflexia).

Diagnostics

• Residual urine volume 
• Kidney ultrasound 
• Serum creatinine 
• Typically cystography, cystoscopy and cystometry with urodynamic tests

The preliminary diagnosis established based on the clinical picture. Typically, post-voiding residual urine volume is measured, a renal ultrasound performed to check for hydronephrosis, and serum creatinine is measured to assess renal function.

Further testing is usually not done in patients who cannot self-catheterize or use the restroom (e.g., severely immobilized elderly patients or those with stroke).

Treatment

The prognosis is useful if the disease is diagnosed and treated before kidney damage.

Specific treatment involves catheterization or urinary stimulation measures. Intermittent catheterization is preferred to continuous catheterization when possible. General treatment includes monitoring kidney function, controlling UTIs, drinking plenty of fluids to reduce UTIs and urinary calculi risk, early mobilization after surgery, changing positions frequently, and restricting dietary calcium to prevent calculi.

Catheterization

To treat a flaccid bladder, especially if the cause is acute spinal cord injury, continuous or intermittent bladder catheterization is necessary. Intermittent self-catheterization preferred over permanent self-catheterization, which is a high-risk factor for recurrent UTI and urethritis, periurethritis, prostate abscess, and urethral fistulas in men. Suprapubic catheterization can be used if patients cannot self-catheterize.

Drug and other therapies

Treatment for a spastic bladder depends on the patient’s ability to retain urine. Patients who can keep sufficient volumes of urine can use urinary induction techniques. For patients who are unable to maintain adequate amounts of urine, drug treatment prescribed.

Surgery

Surgical treatment is the last resort. It usually used when patients are at risk of severe acute or chronic complications or for social reasons. And also, in case of spasticity or quadriplegia, when it is impossible to use continuous or periodic drainage of the bladder.