Neurogenic bladder

Question 1

Four main aetiologies of neuropathic bladder?

Answer 1

Impaired cortical control
Emotional state
Drugs e.g. alcohol, sedatives
Spinal cord.nerve damage

Question 2

An example of an excessive sensory stimuli which can lead to “sensory urge incontinence”?

Answer 2

Severe pain from cystitis/urethritis

Question 3

Which spinal nerves constitute the sacral outflow?

Answer 3

S2, 3, 4

Question 4

Why is the sacral outflow crucial to maintaining continence?

Answer 4

Supplies parasympathetic supply to detrusor;

Recieves sensory information from bladder stretch receptors

supplies somatic motor innervation of the external sphincter (pudendal nerve), pelvic floor muscles (nerve to levator ani)

Question 5

Spinal cord damage at/below T12/L1 causes what pattern of incontinence?

Answer 5

Flaccid bladder with overflow due to lack of pressure sensation and lack of detrusor activity

Question 6

What happens if there is spinal injury between the sacral segment and the pontine micturition centres?

Answer 6

Patient develops a “reflex bladder”- detrusor overactivity, synchronous with external sphincter contraction

Question 7

What are the consequences of detrusor-sphincter dyssynergia?

Answer 7

Thickening of the bladder and poor emptying; leading eventually to back-pressure causing renal impairment

Question 8

What are the consequences of prolonged urinary stasis? (3)

Answer 8

Infection, stones, tumours

Question 9

How can diabetes cause incontinence?

Answer 9

Autonomic neuropathy leading to atonic bladder, stasis, overflow