Neurogenic Bladder

Neurogenic lower urinary tract dysfunction (NLUTD) is abnormal control of the bladder, bladder neck, or urinary sphincters caused by a neurologic lesion. Normal urination requires two coordinated phases: the detrusor muscle stores urine at low pressure, then contracts while the outlet relaxes. A lesion can disrupt storage, emptying, or the timing between those actions. The neurologic level matters because the pontine micturition center coordinates bladder contraction with sphincter relaxation, while the sacral micturition center and peripheral nerves carry out the reflex. The same symptom—such as incontinence—can therefore arise from an overactive bladder that empties too soon, or from retention with overflow around a persistently full bladder. The post-void residual and pressure pattern help separate them. A patient may feel comfortable, remain continent, and still sustain renal injury. Sustained high storage pressure and poor bladder compliance can transmit pressure toward the ureters, causing vesicoureteral reflux, hydronephrosis, renal scarring, and declining renal function before symptoms become obvious. Symptom relief is not proof that the bladder is safe. After an acute spinal cord injury, spinal shock temporarily suppresses reflex bladder activity. The bladder...