Bladder Neck Dysfunction in Spinal Cord Injury

Spinal cord injury (SCI) impairs the voluntary and autonomic control of storage and emptying functions of the urinary bladder, leading to a marked remodulation of the micturition reflex. Autonomic dysreflexia (AD) is found in SCI patients with a lesion level above T6. The occurrence of AD in SCI patients may also result in bladder neck dysfunction, which is often associated with AD and may cause bladder neck obstruction or inhibit detrusor contractility. Patients with bladder neck dysfunction may present with normal or underactive detrusor contractility, resulting in inefficient bladder emptying and prolonged AD. Using videourodynamic study, bladder neck dysfunction can be clearly demonstrated as a narrow bladder neck associated with a narrow external urethral sphincter and normal detrusor contractility. Medical treatment with α-adrenergic agents is the first-line treatment for patients with bladder neck dysfunction. If medical treatment fails, transurethral incision of the bladder neck is indicated to relieve bladder outlet obstruction and to resume spontaneous detrusor contractility.