Diagnosis and Management of Neurogenic Bladder Dysfunction

Abstract

Background: The function of the LUT is mainly storage and voiding of urine, which is regulated by the nervous system that coordinates the activity of the urinary bladder and bladder outlet. The part of the nervous system that regulates LUT function is disseminated from the peripheral nerves in the pelvis to highly specialized cortical areas. Any disturbance of the nervous system involved, can result in neuro-urological symptoms [1]. Methods: this article was done after retrospective longitudinal and observational study including patients with neurogenic bladder and reviewing national and international recent and related literatures to overview neurogenic bladder and most advanced medical and surgical diagnostic procedures and treatment modalities of neurogenic bladder. Results: Among patients included, 52% had an early referral. The majority were diagnosed as neurogenic bladder with high bladder pressure and low bladder compliance and were treated with oxybutynin and intermittent catheterization. Urodynamic follow-up results showed 68% of improvement at the second urodynamic examination decreasing bladder pressure and increasing bladder capacity and compliance. The percentage of incontinence and urinary tract infections decreased over treatment. Conclusion: Multiple conservative modalities, i.e pharmacologic agents, medical devices and neuro modulation, should be promoted before undertaking surgical interventions. Intermittent catheterization and drug therapy are usually sufficient for maintaining continence and preserving upper tracts. Surgical procedures should be considered if conservative measures fail to achieve continence between catheterizations or preserve upper tracts. However today the improvement of Quality of life is the final goal.