Neurogenic bladder?

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Posted by HFHS M.D.-MS on March 18, 1998 at 18:06:45:

In Reply to: Re: Re: Neurogenic bladder? posted by P.S. on March 17, 1998 at 21:37:14:

: : : I have been having problems with retention. I sometimes retain up to half of the bladder content. I have also had severe spasms of the bladder. I went to a Urologist who did a thorough workup and diagnosed me with a neurogenic bladder. He started me on Ditropan, 10mg, 3x daily, and self-cath., twice daily. This seems to be helping quite a bit. Now the question, I went to a different Dr., who said I do not have a neurogenic bladder because my bladder capacity is very large, up to 1000cc. He said a neurogenic bladder is small. Is this true? Your help would be appreciated. I am undergoing neurological workup for possable MS., however to date all tests except the bladder have been normal.
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  : Dear PS
  : Thanks for your questions.
  : A truly neurogenic bladder is bladder dysfunction found in a  patient with a neurologic disorder.  The volume is not necessarily a factor in the diagnosis although most neurogenic / high pressured bladders are usually smaller than normal.  The volume of your distended bladder can be from chronic stretching or partly from the ditropan.  We see some normal bladders which are 1000 cc.   The only way to diagnose a truly neurogenic bladder is with urodynamics testing, x-rays and pressure monitoring  of the bladder during filling and emptying, off Ditropan.  This test will help categorize the status of your bladder dysfunction and tailor treatment.  
  : More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).  Drs Kirkemo and Burks are our urodynamic specialist.  We can also arrange local accommodations through this number if this is your need. Please bring any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.
  : This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
  : Sincerely;
  : HFHS-M.D. MS
  : * Keyword: neurogenic bladder
  Thanks for your quick reply. The urologist I saw did do this test. They filled the bladder and exrayed while they were doing different procedures, including watching how the bladder empties. He did a scope where they actually view the inside of the bladder. That was why he diagnosed it as a neurogenic bladder. I was just wondering why another Dr.(neurologist), just because the bladder emptied once, after taking ditropan for two and a half months, decided to call it a myogenic bladder, instead of my Urologist's diagnoses of neurogenic bladder? Considering he didn't even examining my bladder. Thanks P.S.
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Dear PS
Bladder pathophysiology is a difficult topic.  In the strictest sense neurogenic implies a nerve and myogenic implies a muscle defect.  There are at least three different nerve systems that innervate (supply) the bladder.  One that affects tells the bladder muscles to contract.  One that allows the bladder to stretch and hold urine and when your bladder is full.  Another nerve system controls the  opening  or closing of the  bladder outlet.
There are multiple  diseases that affect the  bladders ability to contract and push urine out.  The bladder muscle needs its nerve supply to remain healthy. A “nerveless”  bladder muscle can get too weak to work  if  nerve impulses are not restored soon. In cases like diabetes,  the nerves that tells you your bladder is full, become damaged and then the bladder muscle can get too stretched to work.
Urodynamic testing can measure the pressure generated by the bladder muscle.  If the bladder does not generate pressure, this test will not tell you if the muscle or the nerve to the muscle is the primary problem.  One or both lesions leave you with the same defect, a bladder that will not work.  In this sense,  it is conceivable that myogenic or neurogenic could be used interchangeably but myogenic is probably more specific.  I assume your urologist knew that neurologic diseases can cause the bladder dysfunction and referred you to a neurologist.    If you want to know the whole story, you need to know what the disease process is then one can infer how it affects bladder contraction.  
More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568). We can also arrange local accommodations through this number if this is
your need. Please bring any physicians’ notes and lab test results that
you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely;
HFHS-M.D. MS
* Keyword: Neurogenic bladder, Myogenic bladder