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Neurogenic bladder is a dysfunction of urinary storage or voiding due to neurologic disease or injury affecting the brain, spinal cord, or peripheral nerves that control bladder function. This condition can result in either overactive bladder with urgency and incontinence, or underactive bladder with retention and incomplete emptying. Common causes include spinal cord injury, multiple sclerosis, diabetes, stroke, and Parkinson's disease.
Normal bladder function requires coordinated communication between the central nervous system, peripheral nerves, and bladder smooth muscle. In neurogenic bladder, disruption of neural pathways leads to detrusor-sphincter dyssynergia, where the bladder muscle and urethral sphincter fail to coordinate properly. Upper motor neuron lesions typically cause detrusor overactivity, while lower motor neuron lesions result in detrusor underactivity and areflexic bladder.
Diagnosis involves comprehensive history focusing on neurologic symptoms, voiding patterns, and associated conditions, followed by physical examination including neurologic assessment. Urodynamic studies are gold standard for evaluating detrusor function and bladder capacity, while post-void residual measurements help assess emptying efficiency. Management strategies are tailored to the specific type of dysfunction, ranging from clean intermittent catheterization and anticholinergics for overactive bladder to surgical interventions for severe cases.