Neurogenic Bladder

What is a neurogenic bladder?

A neurogenic bladder occurs when the bladder does not function normally because of a condition affecting the spinal cord.

What are signs and symptoms of a neurogenic bladder?

Signs of a neurogenic bladder can vary from inability to void, inefficient voiding, constant urine leakage or recurrent urinary tract infections. It is also commonly associated with severe constipation. It is commonly seen in patients who are born with spina bifida.

How common is a neurogenic bladder?

Spina bifida occurs in 1 in 1000 births. It is also known as myelomeningocele or a form of spinal dysraphism.

How is a neurogenic bladder diagnosed and what tests are done?

Spina bifida is usually diagnosed on prenatal ultrasound. The spinal component is repaired immediately after birth. Neurogenic bladder can occasionally cause high pressures within the bladder with can cause kidney damage and even renal failure in a small percentage of patients. As a result, these children are followed very closely with renal bladder ultrasounds, VCUG tests (which can detect bladder abnormalities or vesicoureteral reflux), and DMSA tests to look for renal damage. These children will also undergo urodynamics testing of the bladder to measure the bladder pressures and help to determine best treatment.

How is a neurogenic bladder treated or managed?

Our approach to treatment of neurogenic bladder centers on the child and the family. We recognize that there are a variety of interventions and it can be difficult to determine which option is best.  We place an emphasis on making sure the kidneys stay safe first, and then at the right age, we work towards getting children continent and out of diapers.

We offer intermittent catheterization with medications as our first attempt to get children dry with surgical reconstruction as a last resort. We offer the complete spectrum of treatments including botox injections to the bladder, bulking agents for the urthra, and complete bladder reconstructions including catheterizable channel for the bladder (also known as a Mitrofanoff) and antegrade  continence enemas (also known as ACE).  We work closely with the Spinal Defects Clinic providers (Physiatry, Orthopedics, Social Work, Physical Therapy, Occupational Therapy, nurses).  Nurses are available for clean intermittent catheterization teaching as well as teaching regarding use of transanal irrigation including cone enemas and Peristeen enemas.