Definition
The neurological bladder is a dysfunction of the lower urinary tract, caused by a neurological damage that compromises the organ itself and / or the local innervation.
The alteration of the physiological mechanisms of bladder filling-emptying can derive from pathologies that affect the central nervous system (such as stroke, spinal trauma, myelomeningocele and amyotrophic lateral sclerosis) or the peripheral nerves that supply bladder and urethra (eg diabetes mellitus, alcoholism, herniated disc, cauda equina and lesions due to extensive pelvic surgery). Other causes include anatomical defects, muscle dysfunction and psychological disorders.
The neurological bladder can be flaccid (hypotonic) or spastic (contracted). Mixed clinical pictures can be caused by many diseases, including syphilis, Parkinson's disease, brain or spinal cord neoplasms and multiple sclerosis.
Most common symptoms and signs *
- Kidney stones
- Erectile dysfunction
- Bladder dysfunction
- Dysuria
- Abdominal pain
- Faecal impaction
- hypercalcemia
- nocturia
- Urethral leaks, sometimes visible only after squeezing the glans
- pollakiuria
- Urinary retention
- Blood in the urine
- Constipation
- Strangury
Further indications
The neurological bladder is recognized by a difficulty in urinating, due to a dysfunction in the bladder filling and / or emptying phase.
Patients with severe neurological deficits suffer from overdistention incontinence, with constant urinary leakage, drop by drop.
Patients with spastic bladder may present symptoms such as urinary frequency and urgency, nocturia or paralysis with sensory dysfunction. Often, a flow obstruction coexists that can exacerbate symptoms such as pain and hematuria. Generally, men also have erectile dysfunction.
Frequent complications include recurrent urinary infections (predisposing factors are bladder and / or kidney stones and urinary stasis), hydronephrosis with vesico-ureteral reflux and, in severe cases, nephropathy.
To establish the presence of the neurological bladder, it is necessary to undergo radiological examinations and urinary ultrasound, cystoscopy and urodynamic tests to assess bladder capacity and detect any obstructive-type problems.
The treatment may include catheterization and pharmacological measures to improve filling and emptying and bladder control. In some cases, surgery (urinary derivation) is considered.
