Neurogenic Bladder: types, ethology, symptoms, diagnosis and treatment methods, our experience to date

Neurogenic lower urinary tract dysfunction is a dysfunction of the bladder, bladder neck, or sphincters associated with some type of neurological disorder. Neurogenic bladder can manifest as three basic clinical conditions: overactive bladder, atonic (flexible) bladder, or urinary incontinence. Treatment depends on the type of neurogenic dysfunction. At the Urology Department of the City General Hospital “8 September”, Skopje, Republic of Macedonia, 12 patients with different clinical presentations and etiology of neurogenic bladder dysfunction have been diagnosed and treated in the last four years. Objectives of the study are determination of the etiology and pathophysiological changes of patients with neurogenic lower urinary tract dysfunction in the study group, analysis of the differences between the symptoms and signs of various types of neurogenic bladder in the treated patients, analysis of the diagnostic results of various types of neurogenic lower urinary tract dysfunction in the study group and comparative analysis of the types and efficacy of conservative and surgical treatment in current practice, published in recent studies, compared with our experience to date. Out of a total of 12 patients, 7 patients or 58.3% were diagnosed with the so-called flaccid or atonic bladder, accompanied by urinary retention, with hydronephrosis on both sides, between the second and fourth stages, continuous presence of mixed uroinfections and the need for catheterization or self-catheterization. 3 patients or 25% were diagnosed with the so-called hyperactive bladder with urinary incontinence, and 2 patients or 16.7% were diagnosed with complete dysfunction of the detrusor, internal and external sphincter, with alternating retention, incontinence and pronounced dysuric complaints. Neurogenic lower urinary tract dysfunction is a constant challenge in urology, and it greatly impairs the quality of life of these patients. The fact that the causes of its occurrence, as well as the clinical picture, differ in each patient, treatment should be based on the principle of an individual approach and it most often requires multimodal and multidisciplinary treatment. Our practice so far has shown the best results, regardless of the type of neurogenic lower urinary tract dysfunction, the combination of mini-invasive surgical treatment with long-term conservative treatment, gives a higher percentage of satisfactory results, and in some cases a definitive resolution of this type of condition. KEYWORDS: neurogenic bladder, neurogenic lower urinary tract dysfunction, atonic bladder, urinary incontinence, overactive bladder, autoimmune diseases.