The neurogenic bladder of non-traumatic origin.

Abstract

1. The normal act of micturition is a motor activity of the detrusor activated by the sacral parasympathetic reflex centres. There are also higher micturition centres accounting for facilitation, inhibition and co-ordination. 2. A lesion of the micturition centres and/or their pathways results in bladder dysfunction known as ‘neurogenic bladder’. 3. The best studied type of neurogenic bladder is that resulting from a transverse spinal lesion. 4. In the case of a complete lesion of the cord uninhibited reflex activity of the bladder can be anticipated, after a variable period of retention. In the event of a lesion of the sacral cord or its nerve roots the loss of reflex activity of the bladder is permanent but urine may be expressed by abdominal straining. In both types of dysfunction corrective surgical procedures may be needed to achieve complete bladder emptying and eliminate infection. 5. Disseminated sclerosis is usually accompanied by bladder dysfunction, overactivity in the early stage and retention later. 6. Tabes and diabetes are selective lesions of the afferent neurone presenting impairment of the desire to micturate. Micturition at frequent intervals should be encouraged. 7. There are other selective diseases of the nervous system with bladder dysfunction which have not yet been fully investigated. 8. A selective lesion of the efferent neurone brings about impaired or abolished inhibition. Frequent micturition (bladder training) is recommended to avoid critical filling. 9. In some senile patients cerebral function is upset by vascular lesions. As a result of this, incontinence develops from a small and over-active bladder, known as ‘geriatric bladder’. There may also be impaired intellectual capacity, often with restlessness, confusional states or depression which makes co-operation difficult. The geriatric bladder is a serious medical and nursing problem and may best be controlled by frequent placing of the patient on a toilet, commode or bedpan, day and night. Anticholinergic drugs, Vasopressin and Imipramine may reduce frequency and control incontinence in some cases.