Urinary Tract Dysfunction in Neurological Disorders

Neuroanatomy, neurophysiology, and dysfunction of the female lower urinary tract: a review

The 2 major functions of the lower urinary tract are the storage and emptying of urine. These processes are controlled by complex neurophysiologic mechanisms and are subject to injury and disease. When there is disruption of the neurologic control centers, dysfunction of the lower urinary tract may occur. This is sometimes referred to as the "neurogenic bladder." The manifestation of dysfunction depends on the level of injury and severity of disruption. Patients with lesions above the spinal cord often have detrusor overactivity with no disruption in detrusor-sphincter coordination. Patients with well-defined suprasacral spinal cord injuries usually present with intact reflex detrusor activity but have detrusor sphincter dyssynergia, whereas injuries to or below the sacral spinal cord usually lead to persistent detrusor areflexia. A complete gynecologic, urologic, and neurologic examination should be performed when evaluating patients with neurologic lower urinary tract dysfunction. In addition, urodynamic studies and neurophysiologic testing can be used in certain circumstances to help establish diagnosis or to achieve better understanding of a patient's vesicourethral functioning. In the management of neurogenic lower urinary tract dysfunction, the primary goal is improvement of a patient's quality of life. Second to this is the prevention of chronic damage to the bladder and kidneys, which can lead to worsening impairment and symptoms. Treatment is often multifactorial, including behavioral modifications, bladder training programs, and pharmacotherapy. Surgical procedures are often a last resort option for management. An understanding of the basic neurophysiologic mechanisms of the lower urinary tract can guide providers in their evaluation and treatment of patients who present with lower urinary tract disorders. As neurologic diseases progress, voiding function often changes or worsens, necessitating a good understanding of the underlying physiology in question.

The effects of a catheter clamping protocol on bladder function in neurosurgical patients: a controlled trial

There is scant evidence-based literature on the best strategies for short-term urinary catheter removal. This clinical trial explored the effects of an early urinary catheter clamping protocol on bladder function in neurosurgical patients. Eligible patients were divided into observation and control groups. Those in the observation group had their catheter clamped postoperatively on return to the ward and unclamped at dedicated intervals. The control group received standard care; the catheter was on free drainage during the entire time in situ. The mean catheter indwelling time was 2.6 days. Compared with the control group, the observation group experienced shorter time to first postoperative urination, less residual urine volume and better subjective perception during their first postoperative urination. For patients undergoing neurosurgery and associated short-term indwelling urinary catheterization, an early catheter clamping protocol is effective in facilitating bladder function, reducing the rate of dysuria and making patients feel more comfortable after catheter removal.