Neurogenic Bladder: Therapy

Patients with neurogenic bladder dysfunction require long-term monitoring to avoid complications (see Consequential Diseases).

General Measures

  • If bladder emptying is not possible to a sufficient degree, intermittent one-time catheterization or suprapubic indwelling catheterization must be performed.
  • 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 (MS); dementia syndromes): Bladder training, ie, the patient must learn to delay the urge to urinate more and more until normal micturition volumes and frequencies (urine volumes and frequency of urination).
  • Detrusor-sphincter dyssynergia (DSD; bladder dysfunction characterized by impaired interaction of the anatomic structures involved in bladder emptying; classically due to spinal cord injury or also in patients with multisystem atrophy, multiple sclerosis (MS)): Disposable catheterization by means of sterile-packed catheters for intermittent self-catheterization or catheterization by others.
  • Hypocontractile detrusor (e.g., due to polyneuropathy (20-40%), disc prolapse (5-18%), multiple sclerosis (MS; up to 20%); iatrogenic after surgery (especially after hysterectomy/uterus removal and rectum resection/partial removal of the rectum (rectum) leaving the sphincter apparatus )): Disposable catheterization
  • Hypoactive sphincter (loss of reflex contraction of the sphincter when abdominal pressure increases; e.g., due to peripheral lesions): Pelvic floor training
  • Nocturia (nocturnal urination): see below nocturia/further therapy/general measures.

Conventional surgical and nonsurgical therapeutic procedures

  • Chronic sacral root stimulation S3 – for hypocontractile detrusorNote: To ensure the efficacy of this procedure, a positive response in a test phase of several days to several weeks is required.
  • Intravesical Botulinum Toxin Injections (Synonym: Intravesical Injections of Botox) – for detrusor overactivity and detrusor sphincter dyssynergiaNote: Botulinum toxin A injections (BoNT-A injections) into the detrusor results in chemical bladder denervation, i.e., elimination of the connection between the nerve and the urinary bladder. Therefore, it is necessary for patients to be able to perform clean self-catheterization, as voluntary bladder emptying is inadequate or even impossible.
  • Intravesical electrotherapy – for hypocontractile detrusor.
  • Percutaneous/transcutaneous tibial nerve stimulation – for detrusor-sphincter dyssynergia.

Regular check-ups

  • Regular medical checkups

Complementary treatment methods