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Abstract
Congenital anomalies such as meningomyelocele and diseases/damage of the central, peripheral, or autonomic nervous systems may produce neurogenic bladder dysfunction, which untreated can result in progressive renal damage, adverse physical effects including decubiti and urinary tract infections, and psychological and social sequelae related to urinary incontinence. A comprehensive bladder-retraining program that incorporates appropriate education, training, medication, and surgical interventions can mitigate the adverse consequences of neurogenic bladder dysfunction and improve both quantity and quality of life. The goals of bladder retraining for neurogenic bladder dysfunction are prevention of urinary incontinence, urinary tract infections, detrusor overdistension, and progressive upper urinary tract damage due to chronic, excessive detrusor pressures. Understanding the physiology and pathophysiology of micturition is essential to select appropriate pharmacologic and surgical interventions to achieve these goals. Future perspectives on potential pharmacological, surgical, and regenerative medicine options for treating neurogenic bladder dysfunction are also presented.
Highlights
Normal micturition involves proper function of both the bladder and urethra
Damage or diseases of the central, peripheral, and autonomic nervous systems may result in neurogenic bladder dysfunction
During the bladder filling stage, supraspinal centers produce inhibition of the pontine micturition center, which results in enhancement of thoracolumbar sympathetic outflow with simultaneous suppression of sacral parasympathetic outflow to the lower urinary tract
Summary
Normal micturition involves proper function of both the bladder and urethra. A detrusor of normal compliance and a physiologically competent urethral sphincter are both necessary to maintain urinary continence. Low pressure filling of the bladder during the urine storage phase while voiding requires coordination of detrusor contraction with internal and external urinary sphincter relaxation. This micturition process is controlled by the central nervous system, which coordinates the sympathetic and parasympathetic nervous system activation with the somatic nervous system to ensure normal micturition with urinary continence [1]. Neurogenic bladder with detrusor overactivity may cause incontinence, which leads to embarrassment, depression and social isolation and may lead to skin decubiti, urethral erosions, and upper urinary tract damage [5]
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