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Investigation and management of neurogenic bladder dysfunction
  1. C J Fowler,
  2. K J O’Malley*
  1. Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to:
 Professor Clare Fowler
 Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK;

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Because of the complex nature of the neural control of the lower urinary tract, complaints about bladder function are common in patients with neurological disease. The main neural circuits controlling the two functions of the bladder—that is, storage and voiding—are trans-spinal so that intact cord connections between the pons and the sacral segments are necessary to sustain physiological control. Furthermore, input from higher centres is critical in the assessment of appropriate timing of voiding and many types of cortical disease can affect the centres involved with this. In addition to the spinal pathways and input from higher centres, the peripheral innervation to the bladder is through the pelvic plexus, sacral, and pudendal nerves.

However, despite this complexity of neural control, when considered from the point of view of possible dysfunctions, these are limited to those causing a failure of storage or those causing a failure of emptying. Most commonly patients with neurological disease have problems with the former and have incontinence. Some patients, however, may have urinary retention. In addition, there is a large group of patients, particularly those with disruption cord disease, who have a combination of incomplete emptying and bladder overactivity.

Although the patients’ symptoms are generally a good guide as to the predominant underlying bladder disorder if it is detrusor overactivity, this is not the case in those with additional incomplete emptying; it is in these cases that investigations determining management are most important.


The investigations of patients with neurogenic bladder dysfunction are aimed at both improving symptoms and also preserving renal tract health.

Prevention of upper tract damage

Following spinal cord trauma and in patients with spina bifida, upper urinary tract damage may occur secondary to the neurogenic bladder dysfunction. This is due to high detrusor pressures both throughout the filling phase (so called poor “compliance”) as well as superimposed detrusor …

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  • * Also Institute of Urology, Middlesex Hospital, London, UK