Pathogenesis (development of disease)
In terms of pathogenesis, the following forms of neurogenic dysfunction of the urinary bladder can be distinguished (ICS – International Continence Society classification).
| Detrusor activity (urinary bladder muscle). | Normal | Hyperreflexia | Hyporeflexia |
| Sphincer externus (external sphincter). | Normal | Hyperreflexia | Hyporeflexia |
| Sensitivity | Normal | Hypersensitivity | Hyposensitivity |
This results in a variety of combinations of urinary bladder dysfunction. Below, the resulting typical constellations:
- Detrusor overactivity (engl. detrusor overactivity; consequence of damage to the nervous system due to diseases, accidents or congenital malformations; e.g. because of central degenerative diseases such as Parkinson’s disease, multiple sclerosis; dementia syndromes).
- Detrusor-sphincter dyssynergia (DSD; bladder dysfunction characterized by impaired interaction of the anatomical structures involved in bladder emptying; classically due to spinal cord injury or also in patients with multisystem atrophy, multiple sclerosis (MS)).
- Hypocontractile detrusor (e.g., due to polyneuropathy (20-40%), disc herniation (5-18%), multiple sclerosis (MS; up to 20%); iatrogenic after surgery (especially after hysterectomy/ hysterectomy and rectal resection/surgical partial removal of the rectum (rectum) leaving the sphincter apparatus in place)).
- Hypoactive sphincter (loss of reflex contraction of the sphincter with an increase in abdominal pressure; e.g., due to peripheral lesions).
Etiology (causes)
Biographical causes
- Genetic burden
- Genetic diseases
- Spina bifida – cleft formation in the spine occurring during embryonic development (sporadic, rarely familial).
- Genetic diseases
- Age – increasing age: for women significantly from 44 years and for men significantly from 64 years.
Disease-related causes.
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).
- Malformations such as:
- Spina bifida (see below “Biographical causes”).
- Spinal dysraphia (group of congenital malformations due to disturbed closure of the neural tube in the skull, spine, and spinal cord), Open – myelomeningocele (meninges and spinal cord bulge out through the vertebral fissure), closed (occult) [Causes of neurogenic urinary bladder dysfunction in children: Prevalence (disease incidence): 85%]
- Tethered cord syndrome – malformation in which the extensions of the spinal cord, the filum terminale, are often fused to the spinal cord sheath by a fibrous cord, so that the lower section of the spinal cord, the conus medullaris is displaced abnormally low (the so-called conus depression); as a result, neurological disorders may occur; ; sporadic occurrence.
Endocrine, nutritional and metabolic diseases (E00-E90).
- Diabetes mellitus (diabetes) with polyneuropathy (nerve damage).
- Funicular myelosis (synonym: funicular spinal disease) – demyelinating disease (degeneration of the posterior cord, lateral cord, and a polyneuropathy/diseases of the peripheral nervous system affecting multiple nerves) caused by vitamin B12 deficiency; symptomatology: motor and sensory deficits that may worsen to paraplegia; encephalopathy (pathological conditions of the brain) of varying degrees.
Infectious and parasitic diseases (A00-B99).
- Tabes dorsalis – late stage syphilis (sexually transmitted disease).
Musculoskeletal system and connective tissue (M00-M99).
- Intervertebral disc prolapse (BSP; herniated disc) → hypocontractile detrusor.
Neoplasms – tumor diseases (C00-D48).
- Tumors in the area of the spinal cord
Psyche – nervous system (F00-F99; G00-G99)
- Apoplexy (stroke) and other cerebrovascular events (20-50%) → detrusor overactivity.
- Anterior spinal artery syndrome (synonym: spinal anterior syndrome) – neurological disorders caused by circulatory disturbances of the anterior spinal artery.
- Dementia syndromes (most commonly in the form of Alzheimer’s disease (Alzheimer’s type dementia, DAT)) → detrusor overactivity.
- Funicular myelosis (synonym: funicular spinal disease) – demyelinating disease (degeneration of the posterior cord, lateral cord, and a polyneuropathy/diseases of the peripheral nervous system affecting multiple nerves) triggered by vitamin B12 deficiency; symptomatology: deficits of motor function and sensitivity that may worsen to paraplegia; encephalopathy (pathological conditions of the brain) of varying degrees.
- Infantile cerebral palsy – neurological disorder whose causative damage to the central nervous system occurs before, during or immediately after birth.
- Alzheimer’s disease
- Parkinson’s disease (shaking palsy) (25-70% of patients, depending on the stage of the disease) → detrusor overactivity.
- Multiple sclerosis (MS) – neurological disease that can lead to paralysis and spasticity (50-90% after prolonged disease progression) → detrusor overactivity and/or detrusor sphincter dyssynergia or hypocontractile detrusor.
- Multisystem atrophy (-50%) → detrusor-sphincter dyssynergia.
- Myelitis (inflammation of the spinal cord), unspecified.
- Peripheral lesions → hypoactive sphincter.
- Polyneuropathy (generic term for diseases of the peripheral nervous system associated with chronic disorders of peripheral nerves or parts of nerves) → hypocontractile detrusor
- Syringomyelia – neurological disorder that usually begins in middle age and results in cavities in the gray matter of the spinal cord
- Cerebral sclerosis – arteriosclerotic changes in the brain vessels.
Injuries, poisonings, and other consequences of external causes (S00-T98).
- Spinal cord injury, unspecified → detrusor-sphincter dyssynergia.
- Traumatic brain injury (TBI), unspecified.
Other causes
