Which are the symptoms?
Overdistention incontinence is the primary symptom in patients with flaccid bladder. Patients retain urine and have constant drip leaks. Men also generally experience erectile dysfunction. Patients with spastic bladder may have frequency, nocturia, and spastic paralysis with sensory deficits; most have intermittent bladder contractions that result in urine leakage and, if they do not have loss of sensation, urgency. In patients with detrusor-sphincter dyssynergy, sphincter spasm during micturition may prevent complete bladder emptying. Frequent complications include recurrent urinary tract infections and urinary stones. Hydronephrosis with vesicoureteral reflux can occur because the large urinary volume generates pressure at the vesicoureteral junction that causes dysfunction with reflux and, in severe cases, nephropathy.
How is it diagnosed?
To establish any nerve injury, it is important to undergo a neuro-urologic examination that, in addition to the typical neurologic examination, includes inspection and palpation of the abdomen, inguinal region, external genitalia, a rectal and pelvic evaluation. This examination, however, cannot always be conducted completely in patients with severe neurological conditions (e.g., spinal trauma, Parkinson's disease, or multiple sclerosis). Other possible examinations are: urine test and urinoculture: to evaluate a possible urinary infection that can worsen neurological bladder symptoms; hematochemical tests: for the risk of renal failure, renal function is checked with a serum creatinine test; radiological examinations of the upper urinary tract: to identify structural abnormalities; cystoscopy: indicated for specific abnormalities such as hematuria, recurrent urinary infections; urodynamic examination, to study neurological changes and measure pathological and physiological factors involved in urine accumulation, transport, and elimination
How is it treated?
- Behavioral therapy
- Intermittent catheterization (in bladder with emptying difficulty)
- Medications (almost exclusively indicated in irritative symptoms)
- Surgery, if conservative treatments fail