Neurogenic Bladder

A neurogenic bladder condition comes with many complications, and we understand it can be overwhelming for parents after their child receives a diagnosis. At CHOC, our specialists at the Urology Center believes an urologic condition shouldn’t put childhood on pause.

What is a neurogenic bladder?

Neurogenic bladder is also known as neuropathic bladder. Urinary system muscles and nerves work together to hold urine in the bladder and then release at the appropriate time. Nerves carry messages from the bladder to the brain and from the brain to the muscles of the bladder to signal a release or tightening. However, the nerves that carry these messages do not function properly in a neurogenic bladder.

What causes neurogenic bladder?

A neurogenic bladder may be secondary to a birth defect or it may be a symptom of a different problem and can be caused by:

• Spina bifida, a defect that occurs during early fetal development
• Spinal cord trauma
• Central nervous system tumors

In many cases, neurogenic bladder is associated with:

• Urine leakage often occurs when the muscles holding urine in the bladder do not get the right message.
• Urine retention is when the muscles holding urine in the bladder do not get the messages to release.
• Damage to the kidney occurs when the bladder becomes too full, increases in pressure and causes increased pressure in kidneys.
• Infection of the bladder or kidneys results from urine held too long.
• Small bladder capacities results from increased muscle activity of the bladder muscle. When a bladder contracts too frequently, the bladder capacity decreases.

What are the symptoms?

A neurogenic bladder is commonly diagnosis shortly after birth when a spinal defect is noted. Some children will have an inability to urinate, be able to urinate in very small quantities, or have incontinence. Each child may experience neurogenic bladder symptoms differently and vary depending on the cause and associated conditions. The specialists at the CHOC Urology Center carefully assess each patient to ensure a proper diagnosis and treatment.

How is a neurogenic bladder diagnosed?

Diagnostic procedures for neurogenic bladder may include:

• VCUG is a specific X-ray that examines the urinary tract and allows specialists to see a direct image of the refluxing ureter.
• Ultrasounds are noninvasive tests that produce sounds waves that transmit a picture onto a screen. Parents may be familiar with ultrasounds for pregnancy.
• Urodynamic study – After the child completes an uroflow and post void residual, a procedure places two thin catheters in the child’s urethra and the anus. The catheters assist in measuring the pressures of the abdomen and bladder during filling and emptying of the bladder. Urology specialists will measure bladder volume and pressure after filling the child’s bladder with saline. CHOC urology specialist can also determine the tone or amount of contraction of the bladder.
• Video Urodynamics is similar to urodynamics, except the bladder is filled with a radiographic dye. During filling and emptying, CHOC specialists will take X-ray images of the bladder. It combines urodynamics and a VCUG into one procedure.
• Home Pressure Tests are at-home tests that measures pressure inside a child’s bladder at different volumes of urine. Learn more about home pressure tests.

What treatments are available?

A pediatric urology team determines specific treatment for a neurogenic bladder based upon:

• The child’s age, overall health and medical history
• The extent of the condition and expected course of the condition
• The child’s tolerance for specific medications, procedures or therapies
• The family’s opinion or preference

Neurogenic bladder treatments will not cure the disorder, but can prevent complications and may include:

• A catheter or hollow tube insertion to empty the bladder regularly (clean intermittent catheterizations).
• Prophylactic (preventive) antibiotic therapy to reduce infection incidence.
• Medications to relax the muscles of the bladder.
• Regular imaging studies (ultrasounds, VCUG, urodyanmics or video urodynamics) to monitor kidneys, ureters and bladder.
• Mitrofanoff, ACE, or bladder augmentation surgeries.
• An artificial sphincter which involves a procedure to place an artificial cuff around the neck of the bladder. The cuff is inflated to prevent urinary incontinence and deflated when it is time to empty the bladder. These children will still require intermittent catheterization to completely empty the bladder.