Diagnosis and treatment of neurogenic bladder]

Bladder function has two phases, urine storage and urine evacuation which are based on the complex neurological controls including central as well as peripheral nervous system. Therefore, various neurological lesions can cause bladder dysfunctions such as disturbed storage or disturbed urine evacuation. Micturitional symptoms can be divided into storage symptoms and voiding symptoms. Storage symptoms include urgency, frequency of micturition and urinary incontinence, on the other hand voiding symptoms include difficulty in starting micturition, prolonged or intermittent micturition and urinary retention. The pathophysiology of bladder dysfunction is known by performing urodynamic studies such as uroflowmetry, residual urine measurement, cystometry, external urethral sphincter electromyography, pressure-flow study and voiding urethrocystography. The most common cause of storage symptom is detrusor overactivity, which can occurs in the central nervous system disorders. Disturbed voiding can be due to poor relaxation of urethral sphincter or detrusor weekness. The treatment of neurogenic bladder usually can be done by the combination of bladder training, intermittent catheterization and pharmacotherapy. It is very important to try to avoid the bladder overdistension which can cause weak detrusor and poor recovery.