Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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The Neural Control of Micturition: A Masterpiece of Coordination
To understand what Neurogenic Bladder means, it helps to know how the lower urinary tract and nervous system work together to control urination. In healthy people, storing and passing urine is not just mechanical. It involves both the autonomic (sympathetic and parasympathetic) and somatic nervous systems, which work together from the brain to the pelvic nerves.
The Hardwiring of the Bladder
The bladder acts as a storage tank, and nerves control how it works. Its ability to hold urine at low pressure and empty completely relies on specific receptors and nerve pathways.
Normal urination relies on three main nerve circuits that work together in a set order. If any part is damaged, the entire system can be affected.
Modern neuro-urology has found that the Periaqueductal Gray (PAG) in the midbrain plays an important role. The PAG links the emotional and thinking parts of the brain with the PMC. It combines feelings like fear or anxiety with the bladder’s physical state. This is why anxiety can make someone feel a sudden need to urinate or cause ‘bashful bladder.’ In neurogenic bladder, the PAG often cannot filter these signals correctly.
Neurogenic Bladder refers to any problem with the bladder, bladder neck, or urethral sphincter caused by disease or injury to the nervous system. It is not a single disease but a group of different conditions. How it shows up—whether the bladder is overactive or cannot empty—depends on where and how much the nerves are affected.
Classification by Lesion Level (Madersbacher Classification Concept)
At Liv Hospital, we use a system that links the location of the nerve injury to how the bladder is likely to act. This helps us predict the risk to the kidneys.
Suprapontine Lesions (Brain Failure)
Suprasacral Spinal Lesions (Spinal Cord Failure)
Result: Detrusor-Sphincter Dyssynergia (DSD). This is the most dangerous type of neurogenic bladder. The bladder tries to empty, but the sphincter closes instead of relaxing. This causes very high pressure, like pushing against a closed door. If not treated, urine can flow backward into the kidneys, causing swelling and kidney failure.
The etiology of urological diseases is diverse, often involving a combination of genetic, environmental, and lifestyle factors.
The Burden of Disease and Historical Context
If not treated, neurogenic bladder can lead to serious illness and even death.
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Not exactly. Overactive Bladder (OAB) is a symptom complex (urgency/frequency) that is usually idiopathic (cause unknown) in otherwise healthy people. Neurogenic Bladder specifically implies a known neurological cause (like MS or Stroke). While a stroke patient has “Neurogenic OAB,” the underlying mechanisms, risks (like kidney damage), and treatments are distinct from those of a healthy person with idiopathic OAB. For example, idiopathic OAB rarely causes kidney failure, whereas Neurogenic Bladder frequently can.
Yes. A massive central disc herniation in the lower back (L4-L5 or L5-S1) can compress the Cauda Equina (the bundle of nerves at the end of the spinal cord). This causes “Cauda Equina Syndrome,” a surgical emergency characterized by painless urinary retention (inability to pee), saddle anesthesia (numbness in the groin/buttocks), and leg weakness. Immediate decompression surgery is required to prevent permanent bladder paralysis.
Yes, significantly. “Diabetic Cystopathy” affects over 50% of long-term diabetics. High blood sugar damages the sensory nerves first (loss of fullness sensation), leading to infrequent voiding and large bladder volumes. Later, it damages the motor nerves and muscle, leading to a weak, floppy bladder that cannot empty (acontractility). This is often insidious and painless until the damage is advanced.
DSD is like pressing the gas and the brake on a car at the same time. The bladder pushes hard against a closed sphincter. This generates massive pressure inside the bladder (often >40 cmH2O). Since the urine cannot go out, it goes up—backing up into the ureters and kidneys (hydronephrosis), which mechanically destroys kidney tissue over time and leads to end-stage renal disease (ESRD).
It depends on the cause. If the nerve damage is temporary (e.g., acute disc herniation treated quickly, or the initial “spinal shock” phase after injury), bladder function may return. In chronic conditions like MS, Parkinson’s, or complete Spinal Cord Injury, the nerve damage is usually permanent. However, the symptoms and risks can be managed entirely with proper treatment, allowing for an everyday, healthy life.
Many people struggle with using catheters. Finding other ways to empty the bladder is key. This is true for those with medical conditions that make
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