Neurogenic Bladder

Neurologic bladder is a neurologic dysfunction of the lower urinary tract. It is recognized by difficulty in urinating, due to dysfunction in the filling or emptying phase (or both). Patients with severe neurological deficits experience difficulty with urine continence or are unable to urinate. Patients with less obvious nerve lesions have symptoms that are not immediately attributable to neurological causes: in these cases the diagnosis may be set by bladder irritation or obstructive problems. Pain is often a warning sign of urological disease, although it is not always perceived by the patient, as it depends on the level of neurological injury. Hematuria may also be an early sign of serious neurologic bladder complications. Lower urinary tract function can be impaired by neurological disorders, psychological disorders, muscular dysfunction, and anatomical defects.

Disruption of the peripheral nerves which supply the bladder and urethra may result from several factors, such as:

• injury or trauma due to extensive pelvic surgery (e.g., abdominal-perineal resection for rectal carcinoma and radical hysterectomy)
• developmental spinal cord diseases (e.g., diabetes mellitus, multiple sclerosis);
• pediatric neurological pathologies (e.g. myelodysplasia, sacral agenesis);
• suprapontine lesions (e.g., Parkinson's disease);
• infectious agents; toxins (e.g., alcohol or heavy metals);
• herpes infections (shingles);
• sacral agenesis;
• bone marrow tumors (compression s. or s. cauda equina).