Neurogenic Bladder

What Is Neurogenic Bladder?

The job of the bladder (urinary bladder) is to store urine at low pressure and, once it is sufficiently full, to empty it voluntarily and in a controlled way.

Loss of bladder function due to damage to any part of the nervous system, whether congenital or caused by trauma, infection, a tumor or similar, is called neurogenic bladder.

Symptoms

Symptoms depend on the location and level of the lesion in the nervous system. The most common symptoms are as follows:

Urinary Incontinence:A severe reduction in bladder capacity, involuntary contractions of the bladder muscle or insufficiency of the urinary control mechanism (sphincter) may cause this.

Difficulty Urinating or Inability to Urinate: This may be caused by the bladder muscle being unable to contract (paralysis) due to nerve damage, or by the urinary control mechanism (sphincter) being unable to relax during urination.

Frequent Urination: Involuntary contractions of the bladder muscle, reduced bladder capacity or loss of the bladder's ability to expand may cause this.

Stone Formation, Urinary Tract Infections and Kidney Failure: These can develop depending on the severity of the impairment in the bladder's filling and emptying functions.

Treatment

Medication

Antimuscarinic Drugs: Used in patients with problems in the filling phase of the bladder, to prevent involuntary bladder contractions and to increase bladder capacity.
Antibiotic Prophylaxis: Used to protect the kidneys, particularly in patients with vesicoureteral reflux and in patients with frequently recurring symptomatic infections.
Alpha-Blockers: If the sphincter (urinary control mechanism), which should relax while the bladder contracts, works out of sync and stays contracted, these drugs, which open the bladder neck, can be added to treatment.
Intravesical Botox Injection

In this procedure, whose effect lasts approximately 6-12 months, the aim is to reduce patients' involuntary bladder contractions and increase bladder capacity, thereby improving symptoms such as frequent urination and urinary incontinence.

In this procedure, which we usually perform under local anesthesia in an office setting, Botox is injected into 20-30 points of the bladder using a special needle.

Neuromodulation (Nerve Stimulation)

This is a treatment that uses electrical current to stimulate the sacral nerves that control the bladder. There are two types of nerve stimulation:

Tibial Nerve Stimulation: A needle for the electrical current is placed near the ankle. The needle passes through the skin and stimulates the tibial nerve, which runs from the inner ankle up the leg to the sacral nerves.

Sacral Neuromodulation (Bladder Pacemaker): In this procedure, electrodes placed in the sacrum, powered by a battery, stimulate the nerves responsible for bladder function and relieve the patient's urinary symptoms.

Bladder Augmentation Surgery: In patients with reduced bladder capacity or impaired bladder expansion, when other treatments have failed, this is performed using bowel to increase bladder volume and capacity.

Clean Intermittent Catheterization (CIC): In cases where the bladder has lost its ability to contract (emptying dysfunction), this is the emptying of the bladder using single-use catheters that become slippery on their own when held under water. How many times a day catheterization is performed is decided according to bladder capacity.