Neurogenic Bladder Dysfunction (NBD)
Neurogenic bladder dysfunction is a general term for any type of bladder dysfunction due to a defined neurological disorder. It comprises all facets of neurogenic dysfunction of the urinary bladder – the sensitivity, the storage function, and the voiding
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Burkhard Karl-Heinz Domurath and Johannes Friedrich Kutzenberger
54.1
Definition
Neurogenic bladder dysfunction is a general term for any type of bladder dysfunction due to a defined neurological disorder. It comprises all facets of neurogenic dysfunction of the urinary bladder – the sensitivity, the storage function, and the voiding function. The term is not a diagnosis by exclusion. The location and the extent of the nerve cell injury determine the kind and the degree of the bladder dysfunction (see Table 54.1). Different types of neurogenic bladder dysfunction are understandable in the model of lower and upper motor neuron injury in patients after spinal cord injury (SCI). Neurogenic overactivity after upper motor neuron lesion usually causes a detrusor-sphincter dyssynergia. Disorders of the brain may also lead to bladder dysfunction. The focus is on the change in bladder sensitivity and impaired inhibition of areas situated below the damage. The pontine coordination center (PMC, PSC) is seldom affected. Therefore, there is no detrusor-sphincter dyssynergia in diseases of the brain.
54.2
Medical History
Starting point for the diagnosis of suspected NBD is the detailed knowledge of the neurological history. Occasionally symptoms of NBD are the first of a hitherto undiagnosed neurological illness. The physician has to ask within the urological part about the sensitivity of the bladder (normal, hyposensitive, hypersensitive), the way of emptying the bladder (normally, triggered, straining, Crédé maneuver, catheterizing, urinary diversion – transurethral, suprapubic, etc.), the frequency of B.K.-H. Domurath, MD, PhD (*) • J.F. Kutzenberger, MD, PhD Department of Neuro-Urology, Werner Wicker Clinic, Im Kreuzfeld 4, Bad Wildungen 34537, Germany e-mail: [email protected]; [email protected] A.S. Merseburger et al. (eds.), Urology at a Glance, DOI 10.1007/978-3-642-54859-8_54, © Springer-Verlag Berlin Heidelberg 2014
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B.K.-H. Domurath and J.F. Kutzenberger
Table 54.1 What causes NBD Brain diseases
Spinal cord pathologies
Lumbosacral neuropathologies
Disorders of peripheral nerval structures
Demyelinating disorders Cerebrovasculary disorders Craniocerebral trauma Craniocerebral tumor Basal nuclei disorders (f. e. M. Parkinson) Dementia Spinal cord injury Spine or spinal cord tumor Spinal vascular disorders Neural tube defects Inflammatory disorders Demyelinating disorders Trauma Congenital malformations, tethered cord inclusively Tumor of cauda equina Herpes zoster Demyelinating disorders Disc herniation Radical pelvical surgery Pelvic fractures
micturition, and the nocturnal micturition. Mandatory is a drinking and voiding diary in which has to be notified incontinence episodes and methods of management of urinary incontinence, too. Questions about defecation and sexual dysfunction should be raised specifically.
54.3
Diagnostics
NBD can never be classified solely on the basis of symptoms. A thorough clinical examination using neurological examination techniques
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