JURNAL

NEUROGENIC BLADDER

HARMITA
ST RAMLAH ANDARIAS

Pembimbing : dr. A. Weri Sompa, Sp.S, M.Kes.

 BACKGROUND
Epidemiology Micturition process is
controlled by the central
Anatomy and
nervous system which
physiology
coordinates the sympathetic
and parasympathetic nervous
Pathophysiology
system activation with the
Neurological somatic nervous system to
Evaluation ensure normal micturition
with urinary continence.
Management Damage or diseases of the
Conclusions central, peripheral, and
autonomic nervous systems
may result in neurogenic
bladder dysfunction.
 EPIDEMIOLOGY
In the United States, neurogenic bladder
affects :
4090% of persons with multiple
sclerosis,
3772% of those with Parkinsonism,
15% of those with stroke,
Less common causes of neurogenic
bladder include diabetes mellitus with
autonomic neuropathy, pelvic surgery
sequelae, and cauda equina syndrome
due to lumbar spine pathology.
ANATOMY AND PHYSIOLOGY
OF THE BLADDER
WHAT IS NEUROGENIC
BLADDER?
 PATHOPHYSIOLOGY OF
NEUROGENIC BLADDER
NEUROLOGICAL EVALUATION
NEUROLOGICAL EVALUATION

PATIENT HISTORY
Prior genitourinary
conditions/surgeries, voiding
history,
voiding complaints (dysuria,
recurrent infections,
hesitancy, Optimally, a patient
nocturia, incontinence, urinary diary with
urgency, voiding pattern, fluid
and/or frequency)
intake, and voiding
Medications :
sedative/hypnotic, issues can help with the
antidepressant, antipsychotic, patient evaluation and
antihistamine, anticholinergic, formulation of treatment
antispasmodic, opiate, alpha recommendations.
adrenergic
agonists/antagonists, and
calcium channel blocking
medications may affect
voiding function.
 NEUROLOGICAL EVALUATION

NEUROLOGICAL EXAMINATION

Should include mental status, reflexes, strength, and

sensation (including sacral dermatomes).
Mechanical issues such as prostate enlargement or
bladder.
Issues with cognition, hand strength and coordination,
joint contractures, mobility, sexuality, social/medical
support, and other factors may impact the type of
bladder rehabilitation.
For spinal cord injured patients, the motor level of spinal
lesion, whether the injury is complete or incomplete,
extremity tone, rectal sensation/tone, presence/ absence
of voluntary rectal tone, and bulbocavernosus reflex.
NEUROLOGICAL EVALUATION

LABORATORY
 Neurogenic Bladder
Surgical Interventions
Management

Goals of management of neurogenic

bladder are to:
1. Achieve/ maintain continence to avoid
the psychological and physical (e.g., skin
maceration and decubiti) consequences
of incontinence.
2. Prevent development of a high pressure
detrusor that can lead to upper urinary
tract damage.
3. Minimize risk of symptomatic urinary
tract infections.
4. Prevent over-distension of the bladder.
 Neurogenic Bladder
Management
Non pharmacologic
Interventions
 Neurogenic Bladder
Management
Pharmacologic
Interventions

Tricyclic Antidepressant Drugs

Anticholinergic (Antimuscarinic) Medications
Cholinergic Agonists
Alpha-2 Adrenergic Agonists
Alpha-1 Adrenergic Antagonists
Benzodiazepines
GABA-B Agonists
Botulinum Toxin
Opioids
Vanilloids
Nerve Growth Factor
Nitrous Oxide Agonists
 Neurogenic Bladder
Management
Nonpharmacologic and
pharmacologic treatments fail to
control neurogenic detrusor
overactivity

Surgical interventions

Procedures to control
detrusor emptying:
Procedures to enhance Urinary diversion
detrusor storage: Bladder sphincter
Neuromodulation for
procedures to
neurogenic detrusor
enhance emptying
overactivity Bladder sphincter
Enterocystoplasty
procedures to
restrict emptying
 CONCLUSIONS
Neurogenic bladder dysfunction can be
successfully treated to achieve goals of urinary
continence, prevention of renal damage from
chronically high detrusor pressures, and
minimizing risk of urinary tract infections or
bladder overdistension.
Terima kasih