Advertisement

Current Urology Reports

, 15:448 | Cite as

Neurogenic Bladder: from Diagnosis to Management

  • Ellen Goldmark
  • Benjamin Niver
  • David A. GinsbergEmail author
Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

Abstract

Patients with spinal cord injury (SCI) present with a wide range and variety of urologic manifestations, depending upon the level of injury. Historically, patients with spinal cord injury experienced significant mortality related to renal failure. Greater knowledge of the pathophysiology of SCI, however, has contributed to a reduction in mortality. It is essential to perform a thorough initial evaluation and regular follow-up of these patients to achieve the primary goal of preservation of renal function, with the secondary goal of optimizing the patient’s quality of life.

Keywords

Spinal cord injury Neurogenic bladder Bladder dysfunction Urodynamics Voiding dysfunction 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Ellen Goldmark and Dr. Benjamin Niver each report no potential conflicts of interest.

Dr. David A. Ginsberg is a consultant and investigator for Allergan.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Bodner DR, Witcher M, Resnick MI. Application of office ultrasound in the management of the spinal cord injury patient. J Urol. 1990;143(5):969–72.Google Scholar
  2. 2.
    Shingleton WB, Bodner DR. The development of urologic complications in relationship to bladder pressure in spinal cord injured patients. J Am Paraplegia Soc. 1993;16(1):14–7.Google Scholar
  3. 3.
    Morcos SK, Thomas DG. A comparison of real-time ultrasonography with intravenous urography in the follow-up of patients with spinal cord injury. Clin Radiol. 1988;39(1):49–50.Google Scholar
  4. 4.
    Hamid R, Bycroft J, Arya M et al. Screening cystoscopy and biopsy in patients with neuropathic bladder and chronic suprapubic indwelling catheters: is it valid? J Urol. 2003;170:425–427.Google Scholar
  5. 5.
    Gousse AE, Meinbach DS, Kester RR et al. Renal ultrasound correlates with renal nuclear scan in upper tract surveillance of spinal cord-injured patients. Top Spinal Cord Inj Rehabil. 2003;8(3):1–7.Google Scholar
  6. 6.
    Killorin W, Gray M, Bennett JK et al. The value of urodynamics and bladder management in predicting upper urinary tract complications in male spinal cord injury patients. Paraplegia. 1992;30(6):437–441.Google Scholar
  7. 7.
    Ku JH. The management of neurogenic bladder and quality of life in spinal cord injury. BJU Int. 2006;98(4):739–45.PubMedCrossRefGoogle Scholar
  8. 8.
    National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. 2/2013 [cited 2014 February 25]; Available from: www.nscisc.uab.edu/publicdocuments/fact_figures_docs/facts%202013.pdf).
  9. 9.
    Stover SL, DeVivo MJ, Go BK. History, implementation, and current status of the National Spinal Cord Injury Database. Arch Phys Med Rehabil. 1999;80(11):1365–71.PubMedCrossRefGoogle Scholar
  10. 10.
    Consortium for Spinal Cord Medicine. Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. J Spinal Cord Med. 2006;29(5):527–73.Google Scholar
  11. 11.
    Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453–66.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    McGuire EJ, Savastano JA. Urodynamics and management of the neuropathic bladder in spinal cord injury patients. J Am Paraplegia Soc. 1985;8(2):28–32.PubMedGoogle Scholar
  13. 13.
    Hiersemenzel LP, Curt A, Dietz V. From spinal shock to spasticity: neuronal adaptations to a spinal cord injury. Neurology. 2000;54(8):1574–82.PubMedCrossRefGoogle Scholar
  14. 14.•
    Sorokin I, De E. Options for independent bladder management in patients with spinal cord injury and hand function prohibiting intermittent catheterization. Neurourol Urodyn. 2013. Important, as one cannot underestimate the difficulty with independent bladder management in this patient population due to limited upper extremity dexterity. Google Scholar
  15. 15.
    Soden RJ et al. Causes of death after spinal cord injury. Spinal Cord. 2000;38(10):604–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Nosseir M, Hinkel A, Pannek J. Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury. Neurourol Urodyn. 2007;26(2):228–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Lapides J et al. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol. 1972;107(3):458–61.PubMedGoogle Scholar
  18. 18.
    Dorsher PT, McIntosh PM. Neurogenic bladder. Adv Urol. 2012;2012:816274.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Cameron AP et al. Bladder management after spinal cord injury in the United States 1972 to 2005. J Urol. 2010;184(1):213–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Abrams P et al. A proposed guideline for the urological management of patients with spinal cord injury. BJU Int. 2008;101(8):989–94.PubMedCrossRefGoogle Scholar
  21. 21.
    Razdan S et al. Current practice patterns in the urologic surveillance and management of patients with spinal cord injury. Urology. 2003;61(5):893–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Singh G, Thomas DG. The female tetraplegic: an admission of urological failure. Br J Urol. 1997;79(5):708–12.PubMedCrossRefGoogle Scholar
  23. 23.
    Jackson AB et al. A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years. Arch Phys Med Rehabil. 2004;85(11):1740–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Bennett CJ et al. Comparison of bladder management complication outcomes in female spinal cord injury patients. J Urol. 1995;153(5):1458–60.PubMedCrossRefGoogle Scholar
  25. 25.
    Pan D et al. Long-term outcomes of external sphincterotomy in a spinal injured population. J Urol. 2009;181(2):705–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Yang CC, Mayo ME. External urethral sphincterotomy: long-term follow-up. Neurourol Urodyn. 1995;14(1):25–31.PubMedCrossRefGoogle Scholar
  27. 27.
    Eastwood EA et al. Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury–1990–1997. Arch Phys Med Rehabil. 1999;80(11):1457–63.PubMedCrossRefGoogle Scholar
  28. 28.
    Kessler TM, Ryu G, Burkhard FC. Clean intermittent self-catheterization: a burden for the patient? Neurourol Urodyn. 2009;28(1):18–21.PubMedCrossRefGoogle Scholar
  29. 29.
    Dmochowski RR, Ganabathi K, Leach GE. Non-operative management of the urinary tract in spinal cord injury. Neurourol Urodyn. 1995;14(1):47–55.PubMedCrossRefGoogle Scholar
  30. 30.
    Wyndaele JJ, Madersbacher H, Kovindha A. Conservative treatment of the neuropathic bladder in spinal cord injured patients. Spinal Cord. 2001;39(6):294–300.PubMedCrossRefGoogle Scholar
  31. 31.
    Warren JW. Catheter-associated urinary tract infections. Int J Antimicrob Agents. 2001;17(4):299–303.PubMedCrossRefGoogle Scholar
  32. 32.
    Morton SC et al. Antimicrobial prophylaxis for urinary tract infection in persons with spinal cord dysfunction. Arch Phys Med Rehabil. 2002;83(1):129–38.PubMedCrossRefGoogle Scholar
  33. 33.
    De Ruz A, Garcia Leoni E, Herruzo Cabrera R. Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol. 2000;164(4):1285–9.CrossRefGoogle Scholar
  34. 34.
    West DA et al. Role of chronic catheterization in the development of bladder cancer in patients with spinal cord injury. Urology. 1999;53(2):292–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Sugimura T et al. Chronic suprapubic catheterization in the management of patients with spinal cord injuries: analysis of upper and lower urinary tract complications. BJU Int. 2008;101(11):1396–400.PubMedCrossRefGoogle Scholar
  36. 36.
    Mitsui T et al. Is suprapubic cystostomy an optimal urinary management in high quadriplegics? A comparative study of suprapubic cystostomy and clean intermittent catheterization. Eur Urol. 2000;38(4):434–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Yavuzer G et al. Compliance with bladder management in spinal cord injury patients. Spinal Cord. 2000;38(12):762–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Kass EH. Asymptomatic infections of the urinary tract. Trans Assoc Am Phys. 1956;69:56–64.PubMedGoogle Scholar
  39. 39.
    Nickel JC, Grant SK, Costerton JW. Catheter-associated bacteriuria. An experimental study. Urology. 1985;26(4):369–75.PubMedCrossRefGoogle Scholar
  40. 40.
    Liedl B. Catheter-associated urinary tract infections. Curr Opin Urol. 2001;11(1):75–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Warren JW. The catheter and urinary tract infection. Med Clin N Am. 1991;75(2):481–93.PubMedGoogle Scholar
  42. 42.
    Katsumi HK et al. Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters. Spinal Cord. 2010;48(4):325–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Weld KJ, Dmochowski RR. Effect of bladder management on urological complications in spinal cord injured patients. J Urol. 2000;163(3):768–72.PubMedCrossRefGoogle Scholar
  44. 44.
    Hadley EC. Bladder training and related therapies for urinary incontinence in older people. JAMA. 1986;256(3):372–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Ersoz M, Akyuz M. Bladder-filling sensation in patients with spinal cord injury and the potential for sensation-dependent bladder emptying. Spinal Cord. 2004;42(2):110–6.PubMedCrossRefGoogle Scholar
  46. 46.•
    Stohrer M et al. EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol. 2009;56(1):81–8. Important as this provides European guidelines on management of neurogenic bladder patients. Although not a U.S. based guideline, still can be used to see how these patients are best managed.PubMedCrossRefGoogle Scholar
  47. 47.
    del Popolo G et al. Controversy over the pharmacological treatments of storage symptoms in spinal cord injury patients: a literature overview. Spinal Cord. 2012;50(1):8–13.PubMedCrossRefGoogle Scholar
  48. 48.
    Benner JS et al. Patient-reported reasons for discontinuing overactive bladder medication. BJU Int. 2010;105(9):1276–82.PubMedCrossRefGoogle Scholar
  49. 49.
    O'Leary M et al. Effect of controlled-release oxybutynin on neurogenic bladder function in spinal cord injury. J Spinal Cord Med. 2003;26(2):159–62.PubMedGoogle Scholar
  50. 50.
    Tyagi P et al. Investigations into the presence of functional Beta1, Beta2 and Beta3-adrenoceptors in urothelium and detrusor of human bladder. Int Braz J Urol. 2009;35(1):76–83.PubMedCrossRefGoogle Scholar
  51. 51.
    Yamaguchi O. Beta3-adrenoceptors in human detrusor muscle. Urology. 2002;59(5 Suppl 1):25–9.PubMedCrossRefGoogle Scholar
  52. 52.••
    Cruz F et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur Urol. 2011;60(4):742–50. Very important – this, along with study by Ginsberg et al., demonstrated that BoNT-A could be used in this patient population, which is a very important aspect of treating NDO today.PubMedCrossRefGoogle Scholar
  53. 53.••
    Ginsberg D et al. Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol. 2012;187(6):2131–9. Very important – this, along with study by Cruz et al., demonstrated that BoNT-A could be used in this patient population.PubMedCrossRefGoogle Scholar
  54. 54.
    Abrams P et al. Sixth report on the standardisation of terminology of lower urinary tract function. Procedures related to neurophysiological investigations: electromyography, nerve conduction studies, reflex latencies, evoked potentials and sensory testing. The International Continence Society Committee on Standardisation of Terminology, New York, May 1985. Scand J Urol Nephrol. 1986;20(3):161–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Goldmark E, Yuh B, Ginsberg D. Changes in bladder management in patients with neurogenic bladder with FDA approval of Onabotulinumtoxin A: aRetrospective review. 2014: In: SUFU Meeting. 2014.Google Scholar
  56. 56.
    Grosse J, Kramer G, Stohrer M. Success of repeat detrusor injections of botulinum a toxin in patients with severe neurogenic detrusor overactivity and incontinence. Eur Urol. 2005;47(5):653–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Mehta S et al. Meta-analysis of botulinum toxin A detrusor injections in the treatment of neurogenic detrusor overactivity after spinal cord injury. Arch Phys Med Rehabil. 2013;94(8):1473–81.PubMedCrossRefGoogle Scholar
  58. 58.
    Dykstra DD, Sidi AA. Treatment of detrusor-sphincter dyssynergia with botulinum A toxin: a double-blind study. Arch Phys Med Rehabil. 1990;71(1):24–6.PubMedGoogle Scholar
  59. 59.
    Ross JC, Damanski M, Gibbon N. Resection of the external urethral sphincter in the paraplegic; preliminary report. J Urol. 1958;79(4):742–6.PubMedGoogle Scholar
  60. 60.
    Reynard JM et al. Sphincterotomy and the treatment of detrusor-sphincter dyssynergia: current status, future prospects. Spinal Cord. 2003;41(1):1–11.PubMedCrossRefGoogle Scholar
  61. 61.
    Chancellor MB et al. Sphincteric stent versus external sphincterotomy in spinal cord injured men: prospective randomized multicenter trial. J Urol. 1999;161(6):1893–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Wilson TS, Lemack GE, Dmochowski RR. UroLume stents: lessons learned. J Urol. 2002;167(6):2477–80.PubMedCrossRefGoogle Scholar
  63. 63.
    Catz A et al. The role of external sphincterotomy for patients with a spinal cord lesion. Spinal Cord. 1997;35(1):48–52.PubMedCrossRefGoogle Scholar
  64. 64.
    Fontaine E et al. Reappraisal of endoscopic sphincterotomy for post-traumatic neurogenic bladder: a prospective study. J Urol. 1996;155(1):277–80.PubMedCrossRefGoogle Scholar
  65. 65.
    Carrion HM, Brown BT, Politano VA. External sphincterotomy at the 12 o'clock position. J Urol. 1979;121(4):462–3.PubMedGoogle Scholar
  66. 66.
    Ricottone AR et al. Long-term follow-up of sphincterotomy in the treatment of autonomic dysreflexia. Neurourol Urodyn. 1995;14(1):43–6.PubMedCrossRefGoogle Scholar
  67. 67.
    Santiago JA. Sphincterotomy failure. J Am Paraplegia Soc. 1993;16(3):164–8.PubMedGoogle Scholar
  68. 68.
    Kiviat MD. Transurethral sphincterotomy: relationship of site of incision to postoperative potency and delayed hemorrhage. J Urol. 1975;114(3):399–401.PubMedGoogle Scholar
  69. 69.
    Vapnek JM, Couillard DR, Stone AR. Is sphincterotomy the best management of the spinal cord injured bladder? J Urol. 1994;151(4):961–4.PubMedGoogle Scholar
  70. 70.
    Chartier-Kastler EJ et al. Long-term results of augmentation cystoplasty in spinal cord injury patients. Spinal Cord. 2000;38(8):490–4.PubMedCrossRefGoogle Scholar
  71. 71.
    Gurung PM et al. Long-term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: a minimum of 10 years of follow-up. BJU Int. 2012;109(8):1236–42.PubMedCrossRefGoogle Scholar
  72. 72.
    Chartier-Kastler EJ et al. Neurogenic bladder management and cutaneous non-continent ileal conduit. Spinal Cord. 2002;40(9):443–8.PubMedCrossRefGoogle Scholar
  73. 73.
    Madersbacher S et al. Long-term outcome of ileal conduit diversion. J Urol. 2003;169(3):985–90.PubMedCrossRefGoogle Scholar
  74. 74.
    Gonzalez R, Merino FG, Vaughn M. Long-term results of the artificial urinary sphincter in male patients with neurogenic bladder. J Urol. 1995;154(2 Pt 2):769–70.PubMedCrossRefGoogle Scholar
  75. 75.
    Daneshmand S et al. Puboprostatic sling repair for treatment of urethral incompetence in adult neurogenic incontinence. J Urol. 2003;169(1):199–202.PubMedCrossRefGoogle Scholar
  76. 76.
    Abdul-Rahman A et al. Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders. BJU Int. 2010;106(6):827–30.PubMedCrossRefGoogle Scholar
  77. 77.
    Ginsberg DA. Indications and complications of cystectomy in patients with neurogenic bladder. J Urol. 2010;184(1):10–1.PubMedCrossRefGoogle Scholar
  78. 78.
    Groah SL et al. Excess risk of bladder cancer in spinal cord injury: evidence for an association between indwelling catheter use and bladder cancer. Arch Phys Med Rehabil. 2002;83(3):346–51.PubMedCrossRefGoogle Scholar
  79. 79.••
    Cameron AP, Rodriguez GM, Schomer KG. Systematic review of urological followup after spinal cord injury. J Urol. 2012;187(2):391–7. Very important – provides excellent review of the long-term follow-up in patients with spinal cord injuries.PubMedCrossRefGoogle Scholar
  80. 80.
    Linsenmeyer MA, Linsenmeyer TA. Accuracy of bladder stone detection using abdominal x-ray after spinal cord injury. J Spinal Cord Med. 2004;27(5):438–42.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Ellen Goldmark
    • 1
  • Benjamin Niver
    • 1
  • David A. Ginsberg
    • 1
    Email author
  1. 1.University of Southern CaliforniaLos AngelesUSA

Personalised recommendations