Adult Medical-Surgical Nursing Renal Module: Neurogenic Bladder

Neurogenic Bladder: Classification  Loss of or impaired nervous and voluntary control of bladder function. There are 2 types of neurogenic bladder:  Spastic (reflex) bladder  Flaccid bladder

Neurogenic Bladder: Spastic Bladder  Most common type  Associated with an upper motor neuron lesion (stroke, brain tumour, trauma to brain or spinal cord, myelomeningocele)  Loss of conscious sensation and cerebral (voluntary) motor control  Injury above reflex arc for voiding: the bladder empties on reflex  (Involuntary emptying → intermittent incontinence)

Neurogenic Bladder: Flaccid Bladder  Associated with a lower motor neuron lesion below the reflex arc for voiding (trauma to lower spinal cord S2 – S4, or a complication of diabetes mellitus, autonomic neuropathy)  The flaccid bladder fills and becomes greatly distended → retention with overflow (constant incontinence but bladder full)  Often loss of sensation therefore no discomfort

Neurogenic Bladder: Diagnosis  Patient history and clinical assessment  Measurement of residual urine after voiding by ultrasound or by catheterisation  Urodynamic studies (micturating cystogram)  Urine culture as high risk of infection

Neurogenic Bladder: Complications  Stasis of urine leads to:  Acute or chronic infection (also repeated catheterisation to empty a flaccid bladder increases infection risk)  Reflux: backflow of urine from a full bladder → hydronephrosis, pyelonephritis and renal damage → ESRD  Renal calculi (also risk of bone demineralisation from associated paralysis/ immobility)

Neurogenic Bladder: Aims of Care  This is usually a chronic condition  Care aims at preventing or delaying complications:  To prevent overdistension of the bladder and reflux  To protect and promote sterility of urine and avoid stone formation (concentrated urine)

Spastic Reflex Neurogenic Bladder: Management  Apply a condom or urine bag to control incontinence ( ↓ bacterial count)  Bladder training: 2-hourly voiding  Adequate/ increased oral fluid intake to flush  Frequent patient hygiene/ skin care  May require prophylactic antibiotics

Flaccid Neurogenic Bladder: Management  An indwelling catheter or intermittent catheterisation to reduce overdistension, stasis and reflux  Adequate/ increased oral fluid intake to flush  Good frequent patient hygiene/ skin care  Prophylactic antibiotics  Drugs to improve bladder contraction  Monitor kidney function

Neurogenic Bladder: Nursing Considerations  Emotional and psychological support as well as physical care  Encourage as much self-care as possible to improve self-esteem  Optimal patient hygiene, hand-washing  Monitor urine concentration/ cloudiness  Regular samples for culture  Adequate fluid intake  Patient education related to these points