A neurogenic bladder is an abnormally functioning bladder, either overactive or underactive, caused by damage to the nerves controlling it. This damage may be caused by trauma to the spinal cord or diseases that affect the nervous system. Treatments for neurogenic bladder can include physical-psychological, electrical stimulation and drug therapy; however, in severe cases the following surgical procedures may be necessary.
Bladder Augmentation
Bladder augmentation, also called augmentation cystoplasty, is a surgical procedure to increase the capacity of the bladder. Patients suffering from neurogenic bladder often have a buildup of urine in the bladder that can back up into the kidneys causing further damage. The augmentation cystoplasty uses segments of the bowel tissue to create a wider bladder wall therefore increasing the capacity for urine.
Urethral Stents
For men with an underactive bladder (meaning it is not able to void urine) due to the urinary sphincter failing to allow urine to flow out of the bladder, the insertion of a urethral stent can successfully treat the condition. In this procedure a small tube is inserted into the urethra and through the sphincter keeping it open and allowing urine to flow.
Artificial Sphincter
The muscle that controls the flow of urine out of the bladder is called the urinary sphincter. Damage to the nerves around this muscle can cause the sphincter to not work properly causing leakage or incontinence. In this case surgical implantation of an artificial sphincter may be necessary.
An artificial sphincter consists of a cuff that is surgically inserted around the urethra, a balloon that is placed under the abdominal muscles and an external pump to inflate the cuff. When the cuff is inflated it puts pressure on the urethra closing it off. When you are ready to void, deflate the cuff using the pump and the urine will flow.
Sphincter Resection
A neurogenic bladder that results in the urinary sphincter remaining constricted can be treated by a sphincter resection in which the sphincter muscles are weakened by removing part of the muscle. If the entire sphincter needs to be removed, a procedure called a sphincterotomy, a catheter is used to collect the urine.
Sling Surgery
Patients suffering from a neurogenic bladder often experience bladder leakage, either due to a dysfunctional sphincter or the retention of urine in the bladder causing pressure. Bladder sling surgery uses either artificial materials or tissue from the patient to create a support to hold the neck of the bladder in a proper position applying pressure on the urethra, therefore keeping it closed and preventing leakage.
