Bladder impairment following spinal cord injury

Last revised by Mostafa Elfeky on 18 Jun 2019

Citation, DOI, disclosures and article data

Citation:

Manickam A, Elfeky M, Hacking C, Bladder impairment following spinal cord injury. Reference article, Radiopaedia.org (Accessed on 16 Apr 2024) https://doi.org/10.53347/rID-57838

DOI:

https://doi.org/10.53347/rID-57838

Permalink:

https://radiopaedia.org/articles/57838

rID:

57838

Article created:

16 Jan 2018, Appukutty Manickam

Disclosures:

At the time the article was created Appukutty Manickam had no recorded disclosures.

View Appukutty Manickam's current disclosures

Last revised:

18 Jun 2019, Mostafa Elfeky ◉

Disclosures:

At the time the article was last revised Mostafa Elfeky had no recorded disclosures.

View Mostafa Elfeky's current disclosures

Revisions:

3 times, by 3 contributors - see full revision history and disclosures

Systems:

Urogenital, Spine

Sections:

Classifications

Tags:

bladder, neuro

A commonly used classification scheme used by urologists and rehabilitation specialists, described by Wein, classifies bladder impairment following spinal cord injury according to the level of injury:

suprasacral (infrapontine) bladder - upper motor neuron lesion, releasing the sacral micturition center from descending inhibition. This results in:
- detrusor hyperreflexia/overactivity
- detrusor-external sphincter dyssynergia (DESD), referring to inappropriate co-contraction of the external urethral sphincter (EUS) with voiding detrusor contraction, increases the risk of reflux nephropathy
mixed neurogenic bladder (Type A) - a lesion in the conus medullaris with resulting injury to the sacral micturition center causing detrusor hyporeflexia (under-activity) with external sphincter hyperreflexia with large bladder volumes and overflow incontinence.
mixed neurogenic bladder (Type B) - a lesion involving the pudendal nucleus causing detrusor hyperreflexia with external sphincter hypotonia. This is associated with small bladder volumes, frequency and incontinence.
infrasacral bladder - lower motor neuron lesion involving the conus medullaris or cauda equina resulting in:
- detrusor areflexia and areflexia with atonia of the pelvic floor muscles
- may have isolated increase in bladder neck/internal sphincter resistance due to intact sympathetic supply (arising from T11-L2)
- non-contractile bladder with urinary leakage from overflow incontinence (this may also occur due to recurrent bladder over-distension)

It must be noted that different underlying impairments may lead to a similar outward appearance of bladder dysfunction. For example, detrusor overactivity (hyperreflexia), poor bladder compliance (with increased resistance to filling) or bladder neck insufficiency all can cause storage failure. Similarly, detrusor-sphincter dyssynergia, a non-contractile bladder, myogenic detrusor insufficiency from chronic over-distension or mechanical obstruction (due to benign prostatic hypertrophy, pelvic malignancy or urethral stricture) may lead to voiding failure.