Neurogenic Bladder

Neurogenic bladder, also called neurogenic lower urinary tract dysfunction (NLUTD), is impaired bladder or bladder-outlet function caused by disturbed neurological control. Spinal cord injury, multiple sclerosis, spina bifida, and disorders affecting the brain or peripheral nerves can interrupt the signals that coordinate urine storage and emptying. The bladder may contract too often, contract too weakly, or contract against an outlet that does not relax. Detrusor-sphincter dyssynergia is the dangerous version of that last pattern: the detrusor generates pressure while the urinary sphincter remains closed. The patient may report urgency and leakage, yet still retain a substantial volume. The clinical danger is not limited to wet clothing or inability to void. Persistent high pressure, overdistension, and incomplete emptying can transmit pressure toward the upper urinary tract, promote recurrent infection, cause hydronephrosis, and contribute to declining renal function. A patient can therefore look comfortable while the kidneys are being placed at risk. An RPN assesses and trends the patient’s findings, performs or reinforces care within provincial standards, employer policy, competence, and the prescribed plan, and reports changes promptly. Diagnosing the neurological lesion,...