genitourinary disorders
Neurogenic Bladder
Treatment of Neurogenic Bladder
Catheterization Increased fluid intake Drugs Surgery if conservative measures fail Prognosis is good if the disorder is diagnosed and treated before kidneys are damaged. Specific treatment involves Bladder Catheterization or measures to trigger urination. Intermittent catheterization is preferred to continuous catheterization whenever possible. General treatment includes renal function monitoring, For flaccid bladder, especially if the cause is an acute spinal cord injury, immediate continuous or intermittent catheterization is needed. Intermittent self-catheterization is preferable to indwelling urethral catheterization, which has a high risk of recurrent UTIs and, in men, a high risk of Urethritis , periurethritis, prostatic abscesses, and urethral fistulas. For spastic bladder, treatment depends on the patient’s ability to retain urine. Patients who can retain normal volumes can use techniques to trigger voiding (eg, applying suprapubic pressure, scratching the thighs); anticholinergics may be effective. For patients who cannot retain normal volumes, Treatment , including drugs (see table Surgery is a last resort. It is usually indicated if patients have had or are at risk of severe acute or chronic sequelae or if social circumstances, spasticity, or quadriplegia prevents use of continuous or intermittent bladder drainage. Sphincterotomy (for men) converts the bladder into an open draining conduit. Sacral (S3 and S4) rhizotomy converts a spastic into a flaccid bladder. Urinary diversion may involve an ileal conduit or ureterostomy. An artificial, mechanically controlled urinary sphincter, surgically inserted, is an option for patients who have adequate bladder capacity, good bladder emptying, and upper extremity motor skills and who can comply with instructions for use of the device; if patients do not comply, life-threatening situations (eg, renal failure, urosepsis) can result. 