Diagnosis, Management and Physician Collaboration for Neurogenic Bladder / The Japanese Journal of Rehabilitation Medicine

ABSTRACT

Neurogenic bladder (NB) is a lower urinary tract dysfunction (LUTD) caused by underlying neural diseases that affect the central nervous system and peripheral nerves. LUTD includes urine storage dysfunction and voiding dysfunction. LUTD causes various lower urinary tract symptoms (LUTS) and has a negative impact on patients' quality of life. In addition, urinary tract infection and upper urinary problems can be associated with LUTD, especially with NB. Thus, the diagnosis and management of NB in patients with underlying neural diseases are very important in patient care. LUTD can be screened by a careful history taking of LUTS and simple, non-invasive measures such as postvoid residual urine measurement and uroflowmetry. A urodynamic study is required for precise evaluation of urine storage function and voiding function. Urine storage dysfunction is predominantly caused by detrusor overactivity (involuntary detrusor contractions during bladder filling) and occasionally caused by sphincter deficiency, while voiding dysfunction is caused by detrusor-sphincter dyssynergia (DSD) and/or impaired detrusor contraction. Urodynamic evaluation is mandatory for proper management of NB. Management of detrusor overactivity includes pharmacotherapy using anticholinergics and selective β3-receptor agonist, and neuromodulation. For refractory cases, surgery such as bladder augmentation can be a treatment option. Pharmacotherapy for voiding dysfunction includes α-blockers for DSD and cholinergic agents for impaired detrusor contraction. However, their efficacy has been limited, and not a few patients with NB need urinary management by clean intermittent catheterization (CIC). The goals of urinary management in patients with NB are to render patients free from significant urinary problems, maintain continence, and provide better quality of life. For this purpose, close collaboration between physicians involved in rehabilitation medicine and urology is very important and should be promoted.