NEUROGENIC

BLADDER
Definition

■ Neurogenic bladder is a term applied to urinary bladder malfunction due to neurologic

dysfunction emanating from internal or external trauma, disease, or injury.

Management of neurogenic bladder, 2014

 Physiology
■ Co-ordination of micturition involves control by
three main centres in the central nervous system:
– the cerebral cortex, which exerts the final control by
directing micturition centres to initiate or delay
voiding, depending on the social situation.
– the pontine centre in the brainstem, which is
responsible for co-ordinating relaxation of the
external sphincter with bladder contractions
– the sacral micturition centre, located in the sacral
spinal cord (typically at S3–S4 levels), which is a
reflex centre in which efferent parasympathetic
impulses to the bladder cause a bladder contraction
and afferent impulses provide feedback on bladder
fullness.

Management of neurogenic bladder, 2014

■ Filling Phase:
– Sympathetic Nerve:
■ Inhibit the parasympathetic
nerves from triggering bladder
contractions.
■ Cause relaxation and expansion
of the detrusor muscle.
■ Close the bladder neck by
constricting the internal
urethral sphincter
– Somatic Nerve:
■ contraction of the external
urethral sphincter. 

Management of neurogenic bladder, 2014

■ Voiding Phase:
– Parasympathetic Nerve:
■ trigger contraction of the
detrusor. 
– Sympathetic Nerve:
■ Cause contraction of the
detrusor muscle.
■ Relaxation of the internal
urethral sphincter
– Somatic Nerve:
■ Realxation of the external
urethral sphincter. 

Management of neurogenic bladder, 2014

Types of Neurogenic Bladders

■ the voiding reflexes of the lower urinary intact. The bladder empties too quickly
and too often
■ Sign:
– urge incontinence
– overactive bladder
– Nocturia

EAU Guidelines, 2017

Types of Neurogenic Bladders

■ the external sphincter may

paradoxically contract.
■ If both the bladder and external
sphincter become spastic at the same
time, the affected individual will
sense an overwhelming desire to
urinate but only a small amount of
urine may dribble out.
■ Results to overactive bladder, often
accompanied by urge incontinence.

EAU Guidelines, 2017

Types of Neurogenic Bladders

■ Cause the bladder from emptying and

the patient from sensing a full bladder
disturbed  Urinary retention.
■ If the bladder cannot contract, a
condition called detrusor areflexia is
present, which also leads to the
storage of large urine volumes and
can be accompanied by overflow
incontinence. 

EAU Guidelines, 2017

Types of Neurogenic Bladders

■ Spastic Type:
– Caused by lesion above the sacral micturition center.
– Loss of sensation to empty the bladder and loss of motoric control
– Decrease of Bladder capacity
– Invonluntary Bladder contraction
– High Intravesical pressure

Management of neurogenic bladder, 2014

Types of Neurogenic Bladders

■ Flaccid Type:
– LMN Lession
– Overflow Incontinent
– Spincer Tone Decrease
– Voiding sensation decreaseincrease PVRincrease UTI

Management of neurogenic bladder, 2014

 Classification Neurogenic Bladder
Based on Lession
Lession Symptoms Ultrasound Spincter Detrusor Urodynamic
Storage Insignificant Overactive
Suprapontine Normo-active Detrusor overactivity
Symptoms PVR Urine
Infra Storage and
PVR Urine Overactive Overactive Detrusor overactivity or
pontine/Supra Voiding
Increased Detrusor Spincter Dysinergia
sacral Symptoms
Voiding PVR Urine Underactive or Underactive Hypocontractile or
Infrasacral
Symptoms Increased Normo-active Acontractile Detrusor

Based on Type
Bladder Bladder
Type Lession Symptoms Ultrasound uroflowmetry Detrusor
Pressure capacity
Detrusor overactivity
Urgency, Frequency, PVR Urine
Spastic Above L1 Interupted Flow High or Detrusor Spincter Low
Hesitancy, Retention Increased
Dysinergia

Incomplete emptying, PVR Urine Poor/Absent Underactivity,

Flaccid Bellow L1 Low High
Hesitancy, Retention Increased flow Spincter Insufficient
Reference:
1. Dorsher PT, McIntosh PM. Neurogenic Bladder. Advances in Urology. 2012;2012:816274. doi:10.1155/2012/816274.
2. Blok, B. Fernandez, P. Panneck, J. Castro, D. Popolp, D. Neuro-Urology EAU Guidelines, 2017