Clinical aspects and treatment of neurogenic bladder disorders

Neurogenic disturbance of micturation is categorised as follows: 1. detrusor hyperreflexia with disinhibited bladder, emptying automatically but complete. 2. detrusor-sphincter-dyssynergia with reflex-like incomplete miction and 3. the are-flexic detrusor vesicae with urine retention and bladder overdistension. To avoid nephropathy and urinary tract infection regular miction restoring a low bladder pressure should be achieved. Therapy should also lead to continence. Drug therapy includes anticholinergics to reduce detrusor activity, alpha-sympathicolytics to attenuate sphincter-internus tonus and alpha-sympathomimetics in stress incontinence. Intermittent self-catheterisation, urinary drainage by suprapubic catheter and exercises of pelvic diaphragm are also recommended besides drug therapy for treatment of neurogenic bladder dysfunction in disorders like Parkinson's disease or multiple sclerosis.