Neurogenic Bladder

Kumud P Mehta
Neurogenic Bladder - Investigations
Urine examination routine and culture to detect UTI which is a common clinical presentation of neurogenic bladder with functional obstruction, incomplete voiding and residual urine. Longterm chemotherapy is useful to prevent recurrent UTI.

Plain X-Ray of lumbosacral vertebrae for spina bifida, sacral agenesis.

Ultrasonography of kidneys, ureters and bladder to detect upper tract dilatation like hydronephrosis, hydroureter, hypertrophy of bladder wall in DSD. Due to backpressure transmitted from bladder contractions against a non-relaxing sphincter in DSD; secondary VUR and reflux nephropathy with multiple renal scars occur, chronic renal failure is a consequence of poorly managed neurogenic bladder.

MCU to rule out vesicoureteral reflux / obstructive uropathy

MRI spine in suspected cases to rule out tethering of cord or spinal cord tumors

Kidney function tests to detect azotemia, metabolic acidosis, calcium / phosphorus abnormality, urinary concentrating defects which are due to tubular dysfunction are common metabolic problems.

Urodynamic studies, which measure the activity of detrusor muscle and urethral sphincter, bladder capacity, sensory and motor functions of bladder are important in evaluation of type and severity of bladder dysfunction. This special test helps in diagnosis of type of neurogenic bladder so that drug therapy can be decided to control inappropriate detrusor contraction and relaxation of sphincter. Indication of UDS are (1) wetting with neurologic lesions (2) day and night time enuresis after age of 10 years.

Neurogenic Bladder Neurogenic Bladder 01/03/2001
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