Rigi10™ Malleable Penile Prosthesis
Also Known As
Bladder Disorder, Neurogenic, Bladder, Neurogenic, Neurogenic Bladder Disorder, Neurogenic Dysfunction of the Urinary Bladder, Neurogenic Lower Urinary Tract Dysfunction,
Definition
Neurogenic bladder is a condition characterized by bladder dysfunction that arises from damage or disease affecting the nervous system components that control urination.¹ It occurs when neurological conditions disrupt the complex communication pathways between the brain, spinal cord, and the bladder.² This disruption can lead to an inability to properly store or empty urine.³ The bladder’s primary functions are to store urine produced by the kidneys and to expel it from the body at an appropriate time; these processes are meticulously regulated by nerve signals.² When these controlling nerves are compromised due to illness, injury, or congenital defects, the bladder muscles may fail to contract or relax correctly, leading to a loss of normal bladder control.¹˒³ Depending on the specific nerves affected and the extent of the damage, neurogenic bladder can manifest as either an overactive (spastic or hyper-reflexive) bladder, which contracts too frequently or involuntarily, or an underactive (flaccid or hypotonic) bladder, which loses its ability to contract effectively to empty urine.¹
Clinical Context
Neurogenic bladder is a clinical diagnosis that describes bladder dysfunction resulting from neurological damage or disease. It is not a procedure or device itself, but rather a condition that requires management. Clinically, neurogenic bladder is encountered in patients with a wide array of neurological disorders that impair the normal neural control of urination.¹˒²˒³ These disorders can affect the brain, spinal cord, or peripheral nerves involved in bladder function.⁵˒⁶˒⁷ Relevant medical conditions that commonly lead to neurogenic bladder include spinal cord injuries, which affect over 90% of individuals with such injuries.⁵ Multiple sclerosis is another significant cause, with 50% to 80% of patients experiencing neurogenic bladder dysfunction.⁵ Other conditions include spina bifida (affecting approximately 95% of individuals with this birth defect), Parkinson’s disease, stroke, brain or spinal cord tumors, cerebral palsy, and encephalitis.⁵˒⁷ Nerve damage due to systemic diseases like diabetes (diabetic neuropathy) or pernicious anemia (vitamin B12 deficiency), as well as nerve damage from pelvic surgery or a herniated disk, can also result in neurogenic bladder.⁷ Patient selection for specific treatments for neurogenic bladder depends on the underlying cause, the type and severity of bladder dysfunction (overactive or underactive), the patient’s overall health, and their tolerance for various interventions.⁶˒⁷ The primary goals of management are to protect upper urinary tract function (kidneys), restore or improve lower urinary tract function, achieve urinary continence, reduce residual urine volume, prevent complications like urinary tract infections and kidney damage, and ultimately improve the patient’s quality of life.¹˒⁶ Management strategies are diverse and tailored to the individual. They range from conservative approaches to surgical interventions. Lifestyle changes, such as dietary modifications (avoiding bladder irritants like caffeine and alcohol) and scheduled voiding, are often initial steps.⁵˒⁶ Pelvic floor muscle exercises (Kegel exercises) can be beneficial for some patients.⁷ Clean intermittent catheterization (CIC), where the patient learns to insert a catheter to empty the bladder regularly, is a cornerstone of management for many individuals, particularly those with underactive bladders or significant urinary retention.⁵˒⁶ Continuous catheterization, either urethral or suprapubic, may be necessary for some patients.⁵ Pharmacological treatments include anticholinergic medications (e.g., oxybutynin, tolterodine) to relax an overactive bladder and reduce urgency and frequency, and beta-3 adrenergic agonists (e.g., mirabegron) which also help relax the bladder muscle.⁵˒⁷ Botulinum toxin (Botox®) injections into the bladder muscle can be effective for detrusor overactivity, with effects lasting several months.⁵˒⁶ More invasive procedures may be considered if conservative and pharmacological treatments are insufficient. Sacral neuromodulation (SNS), which involves implanting a device that stimulates the sacral nerves, can help regulate bladder function in some patients with overactive bladder.⁶ Percutaneous tibial nerve stimulation (PTNS) is a less invasive form of neuromodulation.⁶ Surgical options are typically reserved for severe cases or when other treatments fail. These can include bladder augmentation (augmentation cystoplasty), where a segment of the intestine is used to enlarge the bladder, thereby reducing internal pressure and increasing storage capacity.⁵ An artificial urinary sphincter may be implanted to manage severe stress incontinence.⁶ In some cases, urinary diversion procedures, such as an ileal conduit, are performed, where urine is diverted to an external collection bag (stoma).⁵˒⁶ Expected outcomes vary widely depending on the underlying neurological condition, the severity of bladder dysfunction, the chosen treatment, and patient adherence. While a complete cure for neurogenic bladder is often not possible because the underlying nerve damage is usually permanent, effective management can significantly improve symptoms, prevent serious complications like kidney damage and recurrent infections, and enhance the patient’s quality of life.⁵˒⁶ Regular follow-up and urodynamic testing are often necessary to monitor bladder function and adjust treatment plans as needed.¹˒³