Neurogenic Bladder
A malfunctioning urinary bladder due to neurologic dysfunction or insult emanating from internal or external trauma, disease, or injury. There are three types of neurogenic bladder: UTIs are a frequent complication for individuals with spinal cord injury.
Detrusor Sphincter Dyssynergia (DSD)
A lack of coordination between contraction and relaxation of the detrusor muscle and external sphincter. Both contract at the same time causing high intravesical pressure, interrupted or incomplete voiding, and risk of vesico-ureteric reflux. Individuals with lesions L1 and above affected.
Neurogenic Detrusor Overactivity (NDO)
An increased activity of the detrusor muscle. This is usually combined with impaired contractility of the muscle, which leads to overactive bladder symptoms including bladder distention and incontinence.
Detrusor Areflexia
The inability of the detrusor muscle to contract, leading to an inability to empty the bladder. Individuals with lesions below L1 affected.
Investigations
Urodynamic studies (Cystometrogram with or without video fluoroscopy) - used to evaluate detrusor pressure, maximum bladder filling capacity, urge response, motor response. Involves catheterisation (urethral or suprapubic), rectal probe line, saline filling plus or minus xray.
Ultrasound flow rate - used to evaluate flow pattern (sign of obstruction), timing, capacity, residual. Involves pre-filled bladder (patient should have catheter clamped 1 hour prior and have consumed approximately 250mls, 1hr beforehand), pre-void USS, voiding onto flow rate machine, post-void/residual USS.