Neurogenic bladder is a term applied to a dysfunctional urinary bladder that results from an injury to the central or peripheral nerves that control and regulate urination. Injury to the brain, brainstem, spinal cord or peripheral nerves from various causes including infection, trauma, malignancy or vascular insult can result in a dysfunctional bladder 3.
In a large cohort study, the mean age of neurogenic bladder patients was 62.5 years and resultant etiologies included 4:
- multiple sclerosis: ~17%
- Parkinson disease: ~15%
- cauda equina syndrome: ~9%
- paralytic syndrome: ~8%
- stroke complications: ~6%
Depending on the location of the injury in the nervous system, patients typically present with increased frequency, nocturia, urinary incontinence/urgency, urinary tract infection and urinary retention. The bladder may be hyperreflexic, hyporeflexic or areflexic with impaired to no sensation 3.
A number of classification schemes exist for neurogenic bladders, including the Lapides classification which remains popular.
- sensory neurogenic bladder: posterior columns of the spinal cord or afferent tracts leading from the bladder
- motor paralytic bladder: damage to motor neurons of the bladder
- uninhibited neurogenic bladder: incomplete spinal cord lesions above S2 or cerebral cortex or cerebropontine axis lesions
- reflex neurogenic bladder: complete spinal cord lesions above S2 - may lead to pine cone bladder
- autonomous neurogenic bladder: conus or cauda equina lesions
Generally a markedly contracted or distended bladder.
Sensory neurogenic bladder
Inability to sense bladder fullness results in a large rounded and smooth bladder. Voiding is often preserved.
Motor paralytic bladder
Atonic large bladder with the inability of detrusor contraction during voiding.
Uninhibited neurogenic bladder
Rounded bladder with a trabeculated appearance to the mucosa above the trigone from detrusor contractions. On voiding large interureteric ridge is noted
Reflex neurogenic bladder
Results from detrusor hyperreflexia with a dyssynergic sphincter. This leads to contrast extension to the posterior urethra and an elongated pointed urthera with pseudodiverticula.
Autonomous neurogenic bladder
Intermediate between detrusor hyperreflexia (contracted) and dysreflexia (atonic).
Detailed images of the bladder often demonstrate a thick wall with a small contracted or large atonic bladder. A large post-void residual is often noted.
Treatment and prognosis
Depending on the etiology, various techniques can be employed to maintain renal function and prevent urinary tract infections. Self-catheterization, medication or surgical interventions including cystoplasty or sphincterotomy can be employed.
Imaging differential considerations include:
- 1. Jafri SZ, Amendola MA, Diokno AC. Lower Genitourinary radiology, imaging and intervention. Springer Verlag. (1997) ISBN:038794706X. Read it at Google Books - Find it at Amazon
- 2. Appell RA. Voiding dysfunction, diagnosis and treatment. Humana Pr Inc. (2000) ISBN:0896036596. Read it at Google Books - Find it at Amazon
- 3. Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis and management. J. Urol. 2006;175 (3 Pt 2): S5-10. doi:10.1016/S0022-5347(05)00313-7 - Pubmed citation
- 4. Manack A, Motsko SP, Haag-molkenteller C et-al. Epidemiology and healthcare utilization of neurogenic bladder patients in a us claims database. 2010;doi:10.1002/nau.21003 - Pubmed citation