What is Neuropathic Bladder?
Neuropathic bladder occurs when an abnormal nerve supply leads to uncoordinated and abnormal bladder action. This is commonly associated with spina bifida and abnormalities of the spinal cord. Rarely, it can be associated with spinal injury or spinal tumour.
An abnormal nerve supply to the bladder may lead to several scenarios. Firstly, the bladder may become very thick-walled and muscular, and generate abnormal high pressures. The result of this creates pressure on the kidneys and can lead, in severe cases, to urinary tract infections and renal failure. These bladders often require major surgery to replace the normal bladder function.
Alternatively the bladder may be unable to hold on to urine due to weakness of the sphincter. These patients are wet the whole time. Whilst this is safer for the kidneys, it still leaves the child incontinent, and again, bladder reconstructive surgery may be required to alleviate this.
Bladder reconstruction may take a variety of forms. Firstly, the bladder may need to be enlarged and part of the intestine, or ileum, is usually used for this. A leaking bladder may require a strengthened outlet – a bladder neck reconstruction. Any bladder which is enlarged or has its neck reconstructed, will need to be emptied in an alternative fashion other than passing urine via the urethra. For this, the appendix is used to create a channel between the bladder and abdominal wall. A catheter can be passed at intervals and this enables complete bladder emptying, safely. This channel is called a Mitrofanoff channel.
These procedures are used variably according to the precise nature of the neuropathic bladder. Alternatives to major surgery can include drug treatment or the use of a simple urethral catheter. Patients with severe spina bifida or no sensation in the urethra are able to perform this.