Cases Of Neurogenic Bladder Research Articles

LOW-INTENSITY SHOCKWAVE TREATMENT FOR NEUROGENIC BLADDER WITH CHRONIC URINE RETENTION - CASE REPORT

We present a case of neurogenic bladder accompanied by chronic urine retention in a patient diagnosed with multiple sclerosis (MS). This condition was effectively managed by low-intensity shockwave therapy (Li-ESWT). Low-intensity focused shockwave therapy (Li-ESWT) is becoming increasingly important in the treatment of urological problems. This case study investigates the feasibility and efficacy of using Li-ESWT to reduce post-void residual volume in persons with neurogenic bladder, representing the first examination of its sort. Bladder dysfunction (BD) frequently occurs in patients who have been diagnosed with multiple sclerosis (MS). Bladder dysfunction (BD) can occur due to the impairment of nerve impulses in the central nervous system regions involved for regulating bladder function and managing the contractions of the urinary sphincters, which is caused by the lesions associated with multiple sclerosis (MS). Urinary retention can cause various symptoms, including insufficient bladder emptying, urinary incontinence, frequent urinary tract infections, urosepsis resulting in the development of kidney abscesses due to localised kidney infection, and reduced kidney function. Optimal bladder function is essential for individuals with MS, as it plays a critical role in preserving kidney health, preventing urinary tract infections and incontinence, reducing the frequency of MS episodes, and improving their overall well-being. A 31-year-old woman was referred to our urology office with a chronic urinary tract infection caused by a neurogenic bladder with a significant volume of residual urine. A kidney abscess formation was identified as a complication. Li-ESWT, which stands for low-intensity extracorporeal shockwave therapy, was used as a part of a multimodal strategy to treat the urinary bladder. This treatment was delivered off-label. The therapy was given on a weekly basis for a period of 6 weeks. The procedure included administering 2500 shocks at a rate of four pulses per second, with an energy flux density (EFD) of 0.25 millijoules per square millimetre. The EFD (Energy Flux Density) used in our study exceeded 0.32 mJmm2,4, the fR (frequency rate) was set at 8 Hz (pulses per second), the treatment sessions consisted of 12 cycles of Li-ESWT (Low-Intensity Extracorporeal Shockwave Therapy), and a total of 3000 shocks were administered. At the intervals of one week, three months, six months, nine months, and twelve months following the administration of Li-ESWT and tadalafil 2.5 mg, the post-void residual (PVR) volume was consistently below 50 ml. The Li-ESWT treatment effectively reduced the post-void residual urine volume.Low-intensity extracorporeal shockwave therapy (Li-ESWT) can safely and efficiently decrease the amount of urine left in the bladder after voiding in individuals with neurogenic bladder caused by multiple sclerosis (MS). We have effectively demonstrated that Li-ESWT is a feasible and safe treatment for chronic urine retention, resulting in a decrease of post-void residual (PVR) volume from 200 ml to 50 ml. In the future, Li-ESWT has the potential to be advanced as a more efficacious alternative therapy for individuals experiencing chronic urinary retention. Further investigation is necessary to confirm the effectiveness of ESWT in addressing the neurogenic bladder.

An adapted enhanced recovery protocol for adult augmentation cystoplasty in limited sources countries: A pilot clinical trial.

To investigate an adapted enhanced recovery after surgery (ERAS) protocol in adult augmentation cystoplasty (AC). A total of 33 consecutive cases with a history of refractory idiopathic detrusor overactivity (IDO) or neurogenic bladder (NGB) with low capacity, poor compliance, high sustained detrusor pressure, and whose previous therapeutic methods had failed were enrolled. The adapted ERAS fasting8 hours, high protein, low carbohydrate diet, antibiotics, did not use narcotics as much as possible during anesthesia, acetaminophen, early nasogastric tube removal, neostigmine injection postoperation, metoclopramide, early oral diet, and mobilization were applied, and morbidity and hospital stay duration were analyzed. Twenty-two patients had IDO, and the remained cases were NGB or had low bladder capacity or compliance. The mean age of patients in the IDO group was higher than in NGB cases (P ¼ .020). Following the adapted ERAS protocol implementation, more than two-third of patients returned to a regular diet on the second day postoperation in both groups. The mean (SD) hospital stay duration was 7.7 (1.5) days. Postoperative fasting time was 8.8 6 3. 7 hours, and bowel function was returned 1 day postoperation in 82% of patients. Only 33.3% of adults need postprocedure acetaminophen for 2 days, and in 11 cases, it prescribed for 1 day. All subjects except paraplegic patients had early mobilization 1 day postoperation. Our findings revealed that adapted ERAS protocol could be safe and effective in adult AC. It accompanied by few complications, reduced intestinal motility problems, and a short length of hospital stay.

A large renal bullet that resembles a large renal stone. A rare case scenario.

IntroductionGenitourinary trauma secondary to a gunshot wound is uncommon as it only occurs in about 10% of cases. We present a case of a gentleman who suffered a gunshot wound to the kidney.Presentation of caseA 28 year old man presented with irritative lower urinary tract symptoms (LUTs) since three months. The medical history was irrelevant. He is known case of neurogenic bladder maintained on regular clean intermittent catheterization (CIC). He has history of gunshot to the back since few years that resulted in spinal injury. CTUT showed retained bullet inside the right kidney that look alike hyperdense renal stone, Moreover, multiple vesical stones. The vesical stones were treated with cystolitholapaxy. Given that the patient is asymptomatic, conservative management for the retained right renal bullet is the feasible option.DiscussionBased on the ASST classification, renal gunshot injury results in a grade IV injury. Abdominal exploration was reserved only in selected scenarios. Gunshot injuries to the kidney are commonly associated with thoracic and abdominal injuries. Gunshot injuries may be caused by low-velocity or high-velocity bullets. Given the paucity of cases reported in the literature, it is not obvious what is the optimum management of such patients with a retained renal bullet? We present the radiological findings and a clinical case summary as well for those who have Grade IV kidney injury and retained bullet managed conservatively.ConclusionRetained renal bullet post gunshot injury to the back is unusual presentation. A characteristic star-like pattern produced by lead shots and not by “stone,” consisting of plastic detonating cap will aid the urologist to differentiate retained renal bullet from renal stone. In such scenario, asymptomatic renal bullet look alike renal stone doesn't necessitate treatment.

Urological profile of children with microcephaly and congenital zika syndrome

An outbreak of Zika virus disease, a self-limiting arbovirus infection involving skin rash and fever, occurred in Brazil in 2015 and was followed by an increase in newborns with microcephaly and brain malformations. Although two recent studies reported neurogenic bladder in children with microcephaly and congenital Zika syndrome (CZS), urologic evaluation is not yet routine. To investigate the urological profile of children with microcephaly and CZS. A descriptive, cross-sectional study conducted with children with microcephaly undergoing clinical, laboratory, urodynamic and ultrasonographic evaluation at a center for childhood urinary disorders in Salvador, Bahia, Brazil. Thirty-three children were evaluated. Mean age was 40.3±3.2 months (range 35-47 months). Twenty-one (63.6%) were female. None urinated voluntarily. Urine stream was continuous in 22 (66.7%) and intermittent in 3 (9.1%), with no information in 8 cases (24.2%). Abdominal straining during voiding was absent in 27 (81.8%) and present in 3 (9.1%), with no information in 3 cases (9.1%). Upper urinary tract dilatation was not detected in any of the 27 ultrasounds performed. Twenty-two urine cultures were performed, with no cases of bacterial growth. Renal function was normal in all cases (mean creatinine 0.41±0.1mg/dl, range 0.29-0.79mg/dl and urea 20±7mg/dl, 6-36mg/dl). Mean maximum bladder capacity was lower than expected for age: 46.4±25.6mL range 15-110mL versus 135.2±6.6mL, 125.5-153mL, respectively (p<0.0001). Sixteen patients (59.2%) had immature and reflex bladder, 3 (11.1%) had neurogenic bladder with small bladder compliance, 5 (18.5%) had neurogenic bladder and detrusor overactivity and 1 (3.7%) had normal bladder capacity and compliance, but urinated with abdominal straining and a significant residue. Urodynamic evaluation was normal in only two children (7.4%). Most children evaluated had immature and reflex bladder, with no repercussions on the upper urinary tract. Literature on urological complications in children with microcephaly is sparse; however, the present results differ from cases of neurogenic bladder in children with neural tube closure defects. Microcephaly in CZS involves a neurological and urodynamic pattern very similar to that found in children with cerebral palsy. Study limitations include the absence of a control group and neurological data with which to correlate these findings. Neurogenic bladder in children with CZS-associated microcephaly was much less common than recently reported. Most patients had no kidney abnormalities, but small bladder capacity and reflex bladder, with non-significant post-void residual urine.

Experience of a tertiary referral center in managing bladder cancer in conjunction with neurogenic bladder.

Case series. The aim of this study was to present our experience with the management of bladder cancer (BCa) in individuals followed for neurogenic bladder (NB). An Italian tertiary referral center for NB. We retrospectively collected all pre-operative, intra-operative, and post-operative data of our NB cases with BCa, diagnosed from 2004 to 2019. We included ten cases: eight with acquired spinal cord injury (SCI) and two with myelomeningocele (MMC). Considering individuals with acquired SCI, the median age at BCa diagnosis and time since SCI were 53 and 34 years, respectively. One out of seven cases had positive urine cytology. All cases underwent a radical cystectomy, diagnosing squamous cell carcinoma (SCC) and transitional cell carcinoma in 60 and 40% cases, respectively. Surgical-related complications occurred after 90% procedures. Three out of eight individuals with acquired SCI died 2, 12, and 80 months after the diagnosis. Both individuals with MMC presented no evidence of disease after 24 and 27 months. BCa in individuals with NB proved to be associated with a diagnosis at an advanced stage and a high rate of surgical complications. In this population we advocate annual genitourinary ultrasound exam and urine cytology, and cystoscopy in all cases of macrohematuria. Considering the low accuracy of urine cytology and the difficult-to-interpret inflamed bladder walls at cystoscopy in NB, a patient-tailored follow-up schedule based on specific risk factors (e.g., smoking status, indwelling urinary catheter) is mandatory to diagnose and treat BCa at an early stage.

Outcomes of laparoscopic continent catheterizable conduit procedures in children with neurogenic bladder: An 8-year experience in a single center

The continent catheterizeable conduit (CCC) procedure plays an important role in the treatment of children with neurogenic bladder. Laparoscopic procedures offer significant benefits; however, the potential complications should not be ignored. By comparing the complications of CCC in laparoscopic and open neurogenic bladder operations in our center, we aimed to explore the advantages of laparoscopic CCC construction in children. All the cases of neurogenic bladder who had undergone laparoscopic or open lower urinary tract reconstruction at our hospital from June 2009 to December 2016 were retrospectively reviewed. We compared the rates of various complications in the laparoscopic and open groups as well as the appendix and Yang-Monti groups. 61 patients were included in this study. Laparoscopic CCC procedure was performed in 45 cases, 9 were converted to open owing to other combined procedures. Open CCC construction was performed in 16 cases. The mean follow-up time was 4.5 years. Catheterization was safe and uneventful in 72.1% of patients. Complications occurred in 17 cases, including stoma stenosis (n=5), leakage (n=5), mucosal prolapse (n=3), conduit atresia (n=3), and angulation of the conduit (n=1). Eleven cases received surgical revision. There were no statistically significant differences in complication type or rate in the laparoscopic and open group, or in the appendix and Yang-Monti group. Although our study showed a notable complication rate associated with CCC, this did not differ for open and laparoscopic procedures, and laparoscopic procedures can achieve satisfactory results comparable to open procedures. From our single center's experience of lower urinary tract reconstruction, laparoscopic CCC surgery has a shorter hospital stay and no more complications than the open procedure. It is a safe and feasible procedure in children.

Spontaneous rupture of neurogenic bladder

Pneumoperitoneum is abnormal presence of air or any other gas in the peritoneal cavity. This finding can be both benign or a sign of a grave underlying pathology and a wide spectrum of clinical conditions can attribute to the finding. Prompt clinical examination of a case of abdominal pain can identify findings of peritonitis. We are reporting an interesting case report about a patient of acute abdomen with pneumoperitoneum and peritonitis which was caused by spontaneous rupture of urinary bladder. A 36-year-old male, came with complaints of abdominal pain for one day, two episodes of non-bilious vomiting. He was a known case of neurogenic bladder on continuous bladder drainage. Systemic examination of the abdomen showed warmth, diffuse tenderness, guarding and absent bowel sounds. Bladder catheterisation showed clear urine. On investigation, He had pneumoperitoneum in chest X-ray and free fluid in ultrasonography. A clinical diagnosis of hollow viscus perforation was made and emergency laparotomy was done in view of signs of peritonitis. There was rupture of the dome of urinary bladder with necrosis of the bladder wall and extravasation of urine into the peritoneal cavity. This rare presentation should remind us to keep all the differential diagnoses in mind while opening a case of perforation peritonitis as timely intervention can well and truly be the difference between life and death.

Neurogenic bladder in the settings of congenital Zika syndrome: a confirmed and unknown condition for urologists

Congenital Zika syndrome (CZS) is a recently discovered condition that affects central nervous system structures that control the lower urinary tract. The first cases of neurogenic bladder (NB) were recently reported as a sequalae of CZS in neurologically impaired children. Our goal is to further evaluate NB in the setting of CZS, identifying urological risk indicators in hopes that early diagnosis will mitigate the impact of the disease. Urological assessment was performed in all patients with CZS and neurological impairment who were referred to our urodynamic clinic between June 2016 and May 2018. Neurogenic bladder was confirmed by urodynamic evaluation, and urological risk was based on urodynamic results. Sixty-nine patients with CZS were tested. The majority (63 patients, 91.3%) presented with overactive bladder with increased pressures and reduced capacity for age (table 1). Different urodynamic patterns were observed, and the association of reduced bladder capacity for age, high bladder-filling pressure, and increased postvoid residual were frequently observed. NB continues to be consistently diagnosed in our cohort of CZS, mostly with high-risk indicators for renal impairment. When not intervened upon in a timely manner, NB can cause progressive damage to the urinary tract, but the lack of knowledge that CZS causes NB delays investigation and treatment. Parents and health professionals will need to be sensitized to the risks that ZIKV can pose to the urinary tract so that appropriate therapies are initiated to prevent irreversible renal damage. NB is a common condition among our patients with CZS and microcephaly. This is a new cause of NB, unknown to urologists. While further investigation is necessary to understand long-term disease behavior and therapeutic response, increased knowledge among urologists may help to reduce morbidity related to untreated NB and to mitigate the disease burden for patients and families.

Neurogenic Bladder Repair Using Autologous Mesenchymal Stem Cells.

The normal function of the urinary bladder is to store and expel urine in a coordinated, controlled fashion, the activity of which is regulated by the central and peripheral nervous systems. Neurogenic bladder is a term applied to a malfunctioning urinary bladder due to neurologic dysfunction or insult emanating from internal or external trauma, disease, or injury. This report describes a case of neurogenic bladder following laminectomy procedure and long-standing diabetes mellitus with neuropathy treated with autologous cellular therapy. The differentiation potential and paracrine effects of mesenchymal stem cells on bladder function have been highlighted.

Case Report: A case of neurogenic bladder in the setting of Behçet's disease after an initial diagnosis of multiple sclerosis

Behçet’s disease (BD) is an autoimmune vasculitis with an unclear etiology presenting with a classic triad of symptoms including oral and genital ulcers as well as iridocyclitis. A subset of BD patients exhibit neurological symptoms including psychiatric disturbances, balance problems, and voiding dysfunction, and the symptoms of BD can mimic other neurological diseases, including multiple sclerosis (MS). Differentiating between potential diagnoses is challenging due to the lack of specific tests for these disorders and the overlap between clinical symptoms and radiological findings. We describe the case of a 52 year old woman initially diagnosed with and treated for MS. From the urologic standpoint, she was treated for neurogenic detrusor overactivity with detrusor-sphincter-dyssynergia utilizing ileocecal augmentation cystoplasty with a continent stoma for intermittent catheterization. The patient was later diagnosed with BD in light of additional clinical findings.

Should simultaneous ureteral reimplantation be performed during sigmoid bladder augmentation to reduce vesicoureteral reflux in neurogenic bladder cases?

To assess the necessity of performing simultaneous collateral reimplantation during sigmoid bladder augmentation (SBA) to reduce vesicoureteral reflux (VUR) in low-compliance neuropathic bladder with associated VUR. We retrospectively identified 31 patients who underwent SBA alone or with simultaneous ureteral reimplantation at our hospital. The video urodynamics data, VUR status, renal function, and clinical symptoms were studied during follow-up. The mean follow-up time was 57 months (range 12-117). All patients displayed significantly increased safe cystometric capacity (P < 0.001) and bladder compliance (P < 0.001) and decreased creatinine (P < 0.01) and urea nitrogen (P < 0.05) compared with preoperative levels. High-grade VUR was resolved in only 7 of 15 patients (47%) in Group A (simultaneous ureteral reimplantation), whereas low-grade VUR was resolved in 13 of 16 patients (81%) in Group B (SBA alone). The other 11 patients still displaying VUR after SBA had larger safe bladder volumes due to augmentation. The patients' improving renal function benefited most from the enlarged bladder and partly from increased antireflux resistance of vesico-ureter anastomosis. Twelve (38.7%) had recurrent febrile urinary tract infection after SBA, and one (3.2%) suffered from vesico-ureter anastomosis contracture after ureteral reimplantation. A preoperative intravesical VUR pressure of 20 cmH2O is not an effective cutoff point for whether ureteral reimplantation should be simultaneously performed during SBA. Augmentation appears to be more important than reimplantation for protecting kidney from damage due to febrile urinary tract infection after SBA. Simultaneous reimplantation may be not necessary during SBA in neurogenic bladder.

Clinical value of urodynamics examination in diagnosis and treatment of male lower urinary tract symptoms

Objective To evaluate the clinical value of urodynamics examination in diagnosis and treatment of lower urinary tract symptoms (LUTS) in male patients.Methods Laborie urodynamics analysater was applied for the examination of 385 male patients with LUTS and the examination indexes were collected at the same time.The function of bladder and urethra was assessed and grouped according to the definition of international continence society (ICS).The specific treatment was taken according to the grouping.Results The urodynamics examination revealed that there were 283 cases of bladder outlet obstruction (BOO) in 385 male patients with LUTS,including 96 cases of overactive bladder (OAB),38 cases of detrusor muscle asthenia; there were 64 cases of simple OAB,25 cases of neurogenic bladder,13 normal persons.The treatment was taken according to the urodynamics examination result,with the efficiency of 93％.Conclusion The urodynamics examination has great value in diagnosis and treatment for male patients with LUTS. Key words: Urodynamics examination; Male; Lower urinary tract symptoms; Clinical application

Rare Association Between Pernicious Anemia and Neurogenic Bladder – A Case Report and Literature Review

Pernicious anemia is the most common cause of vitamin B12 deficiency, being characterized by destruction of the gastric mucosa and the presence of auto-antibodies. We describe a rare case of neurogenic bladder associated with pernicious anemia. The neurologic manifestations (muscular weakness) were partially reversed with vitamin B12 replacement, but the vesical symptoms persisted. It is important to investigate the presence of vitamin B12 deficiency in cases of neurogenic bladder.DOI: http://dx.doi.org/10.3329/jom.v15i1.19883 J Medicine 2014; 15: 87-90

Morbidity and Efficacy of Ureteroscopic Stone Treatment in Patients with Neurogenic Bladder

There is a lack of information on the safety and efficacy of ureteroscopy in the neurogenic bladder population. We hypothesized that ureteroscopy in patients with neurogenic bladder would be associated with an increased risk of complications and a lower stone clearance rate than in patients without neurological impairment. We reviewed a local registry of patients with ICD-9 codes for urolithiasis between 2004 and 2012. The study cohort was assembled from all eligible patients with neurogenic bladder and a randomly selected control group that had undergone ureteroscopy. Statistical analysis of demographic variables and surgical outcomes was performed. Complications were classified according to the Clavien system. Clearance was defined by computerized tomography, renal/bladder ultrasound or direct ureterorenoscopy. Ureteroscopy was performed a total of 173 times in 127 controls and a total of 45 times in 20 patients with neurogenic bladder. There was no difference between presenting episodes by gender (p = 1.0), race (p = 0.654) or body mass index (p = 0.519). Bacteriuria was associated with the stone episode in 16.4% of controls and 67% of neurogenic bladder cases (p <0.001). Median operative time was significantly longer in those with neurogenic bladder (80.5 minutes, IQR 50-110.5 vs 52, IQR 33-78, p = 0.0003). The proportion of complications was significantly different (p = 0.013). Stones cleared in 86.6% of controls compared to 63% of neurogenic bladder cases (p = 0.004). Patients with neurogenic bladder have increased morbidity after ureteroscopy for upper tract calculi compared to neurologically unaffected controls. Infection has a role in this morbidity. The clearance rate is lower but the stone burden is more significant in those with neurogenic bladder.

Regenerative Medicine Strategies for Treating Neurogenic Bladder

Neurogenic bladder is a general term encompassing various neurologic dysfunctions of the bladder and the external urethral sphincter. These can be caused by damage or disease. Therapeutic management options can be conservative, minimally invasive, or surgical. The current standard for surgical management is bladder augmentation using intestinal segments. However, because intestinal tissue possesses different functional characteristics than bladder tissue, numerous complications can ensue, including excess mucus production, urinary stone formation, and malignancy. As a result, investigators have sought after alternative solutions. Tissue engineering is a scientific field that uses combinations of cells and biomaterials to encourage regeneration of new, healthy tissue and offers an alternative approach for the replacement of lost or deficient organs, including the bladder. Promising results using tissue-engineered bladder have already been obtained in children with neurogenic bladder caused by myelomeningocele. Human clinical trials, governed by the Food and Drug Administration, are ongoing in the United States in both children and adults to further evaluate the safety and efficacy of this technology. This review will introduce the principles of tissue engineering and discuss how it can be used to treat refractory cases of neurogenic bladder.

Postoperative bladder and rectal function in children with sacrococcygeal teratoma

In patients with sacrococcygeal teratoma, the location of the tumor and surgical intervention affects bladder and rectal function. However, there are no clear guidelines for postoperative assessment of bladder function, and the literature on this subject is scarce especially for children requiring multiple surgical interventions. The aim of this study is to evaluate postoperative bladder and rectal function in children with sacrococcygeal teratoma. Retrospective analysis was performed of 25 patients (6 male, 19 female) with sacrococcygeal teratoma operated at our institution from 1998 to 2009. Functional assessment of the bladder and rectum was carried out by clinical follow-up, rectomanometry, and urodynamic studies. Data of 24 children were available for follow-up. Of the 24 children, twelve had bladder dysfunction (50%). Ten children (42%) required more than one surgical intervention. Of the 14 children operated on only once, three developed bladder dysfunction (21%), compared to nine of the 10 children who underwent multiple surgical interventions (90%). All four Altman stages were represented, and bladder dysfunction was found for all tumor types. All children with clinical bladder dysfunction showed abnormalities on urodynamic studies, with seven cases of neurogenic bladder. In contrast, no rectal dysfunction was found. Bladder dysfunction is a common risk of sacrococcygeal tumors. The risk increases particularly if multiple surgical interventions are needed in order to excise the tumor. Therefore, the need for meticulous and complete excision upon first intent is crucial in order to avoid bladder dysfunction.

Neurogenic Bladder

We describe the case of a 73-year-old woman with a history of chronic low back pain and 2 previous lumbar fusions who presented with complaints of worsening back and leg pain. Having previously undergone multiple interventions, physical therapy, and oral analgesics with limited pain relief, the patient opted for endoscopic lysis of adhesions for severe scarring of the epidural space. Subsequently, the patient developed a neurogenic bladder with urinary retention. Three years later, she experienced resolution of the neurogenic bladder symptoms that coincided with the use of the antibiotic nitrofurantoin. Upon discontinuation of the antibiotic, the patient noted that she was unable to void spontaneously. With reinstitution of nitrofurantoin, the patient was once again able to void effectively and has been maintained on nitrofurantoin for >3 years.

Vincristine-induced Peripheral Neuropathy and Urinary Bladder Paralysis in a Child With Rhabdomyosarcoma

Vincristine commonly induces peripheral neuropathy but rarely causes voiding dysfunction. In this report, we describe a case of neurogenic bladder and peripheral neuropathy caused by the neurotoxic effect of vincristine and documented by urodynamic testing and electromyography. Neurologic evaluation aided in monitoring and understanding this problem.

The determination of sensation-dependent bladder emptying time in patients with complete spinal cord injury above T11

Retrospective investigation using urodynamic studies and medical records. To evaluate the safety of sensation-dependent bladder emptying in complete spinal cord injury (SCI) patients, based on the preservation of the desire to void. Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea. This study was performed retrospectively on 79 complete SCI patients with lesions above T11, who had preserved the desire to void during conventional urodynamic studies. Patients were classified according to detrusor compliance and maximal bladder capacity. The clinical and urodynamic characteristics of each group were analyzed. Forty-five (57.0%) patients were classified as group A and 34 (43.0%) patients were classified as group B. There were no significant differences in clinical features, such as voiding methods and the presence of autonomic dysreflexia between the two groups. Compared with group B, there were significantly more areflexic neurogenic bladder cases in group A (P<0.05). There were significantly higher maximal detrusor pressures in group B (P<0.05). There were significantly more cases with the preservation of the strong desire to void in group B (P<0.05). Not all patients with discomplete SCIs accepted the use of sensation-dependent bladder emptying. The safe use of sensation-dependent bladder emptying will be determined based on the results of urodynamic studies.

Clozapine for the treatment of neurogenic bladder

Neurogenic bladder leading to urinary incontinence has been described in patients of stroke, dementia, Parkinson's disease, and some schizophrenia cases with cognitive impairment possibly due to impaired cortical inhibition of the urinary bladder. The underlying brain abnormalities for urinary incontinence are similar in such cases. We report here such a case of neurogenic bladder responding to treatment with clozapine. The possible mechanism of action and clinical implications are described.