Neurogenic bladder dysfunction

Neurogenic bladder dysfunction, often called by the shortened term neurogenic bladder, refers to urinary bladder problems due to disease or injury of the central nervous system or peripheral nerves involved in the control of urination.^[1]^[2] There are multiple types of neurogenic bladder depending on the underlying cause and the symptoms. Symptoms include overactive bladder, urinary urgency, frequency, incontinence or difficulty passing urine.^[3] A range of diseases or conditions can cause neurogenic bladder including spinal cord injury, multiple sclerosis, stroke, brain injury, spina bifida, peripheral nerve damage, Parkinson's disease, multiple system atrophy or other neurodegenerative diseases. Neurogenic bladder can be diagnosed through a history and physical as well as imaging and more specialized testing.^[4] In addition to symptomatic treatment, treatment depends on the nature of the underlying disease and can be managed with behavioral changes, medications, surgeries, or other procedures. The symptoms of neurogenic bladder, especially incontinence, can severely degrade a person's quality of life.^[2]

Neurogenic bladder dysfunction

Urology

Kidney stones, kidney failure, urinary tract infections, hydronephrosis

Creation of a stoma (from the intestines, called "conduit") on the skin of the abdomen that bypasses the urethra to empty the bladder directly through the skin opening. Several techniques may be used. One technique is the Mitrofanoff stoma, where the appendix or a portion of the ileum ('Yang-Monti' conduit) are used to create the diversion.^[9] The ileum and ascending colon can also be used to create a pouch accessible for catheterization (Indiana pouch).

Urinary Diversion:

or urethral sphincterotomy are other surgical approaches that can reduce bladder pressures but require use of an external urinary collection device.^[11]

Urethral stents

may be used in both adults and children ^[12]^[13]^[14]

Urethral slings

have shown good term outcomes in adults and pediatric patients.^[15]^[13]^[16] An artificial urinary sphincter has three components: a control pump, an inflatable cuff that goes around the urethra, and a pressure regulating balloon.^[17] One study on 97 patients followed for a mean duration of 4 years found that 92% percent were continent at day and night during follow up.^[16] However, patients in this study who had intermediate-type bladders underwent adjuvant cystoplasty. Additionally, one study showed that there was no significant difference in success rates between artificial urinary sphincters and sling procedures, however patients tended to need more additional surgeries with the artificial sphincter versus a sling.^[18]

Artificial Urinary Sphincters

Bladder Neck Closure is a major surgical procedure which can be a last resort treatment for incontinence, a Mitrofanoff stoma is necessary to empty the bladder.

[19]

Society and culture[edit]

Burden[edit]

The burden of neurogenic bladder dysfunction on individuals and health care systems is substantial, but the actual costs of care are less understood.^[1]^[27] A recent systematic review of the literature assessed the global costs associated with the current state of care for neurogenic bladder and found that the annual costs of routine care can range from $2,039.69 to $12,219.07, with lifetime costs reaching up to $112,774 when complications are considered.^[1] Catheters and absorbent aids are among the costliest categories of expenditure during routine care.^[1] More invasive and reconstructive treatments were found to be even more costly, with costs ranging from $18,057 to $55,873.^[1]

Neurogenic bladder dysfunction