What is neurogenic bladder?
Neurogenic bladder is a broad term for bladder dysfunction caused by damage or disease affecting the nervous system. The bladder relies on a complex network of nerves to coordinate storage and emptying — when those signals are disrupted, the result can be leakage, inability to empty, dangerous pressure buildup, or all of the above.
Unlike incontinence after prostate surgery, neurogenic bladder often involves the entire lower urinary tract and can directly threaten kidney function if left unmanaged. Treatment is not just about dryness — it is about keeping the upper tracts safe, reducing infection, and giving patients back as much independence as possible.
Quality of Life
Continence, reduced pad use, and freedom from embarrassing or limiting symptoms restore confidence and participation in daily life.
Kidney Protection
High bladder pressures silently damage the kidneys over time. Reducing storage pressure is the most medically critical goal of treatment.
Prevention of Infection
Incomplete emptying, high residual volumes, and stasis promote recurrent UTIs and urosepsis. Effective drainage breaks that cycle.
Independence
The best surgical plan is one the patient can actually manage — whether that means catheterizing through a convenient stoma, operating a device, or simply draining freely.
What causes neurogenic bladder?
Any condition that disrupts communication between the brain, spinal cord, and bladder can cause neurogenic bladder. The underlying cause matters — it shapes how the bladder behaves (overactive vs. underactive, high-pressure vs. low-pressure) and what treatments are appropriate.
How is neurogenic bladder evaluated?
Evaluation is more extensive than for other bladder conditions because the stakes are higher — particularly kidney function. Understanding exactly how the bladder stores and empties, and what pressures it generates, is essential before any treatment decision.
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History & Functional Assessment
Understanding the neurological diagnosis, bladder symptoms, current management, infection history, and how bladder dysfunction affects daily function and independence.
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Urodynamic Studies
The cornerstone of neurogenic bladder evaluation. Measures bladder storage pressure, capacity, compliance, and sphincter behavior. Identifies dangerous high-pressure storage — the primary threat to kidney function — even in patients who appear clinically stable.
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Cystoscopy
Direct visualization of the bladder and urethra to assess anatomy, rule out stones or lesions, and evaluate the urethra before planning surgical reconstruction.
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Upper Tract Imaging
Renal ultrasound or CT urogram to assess kidney size, drainage, and hydronephrosis — evidence of back-pressure from a poorly compliant bladder. Essential at baseline and for ongoing surveillance.
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Laboratory Studies
Renal function (creatinine, GFR), urinalysis, and urine culture to assess kidney health and identify occult infection before any surgical intervention.
First-line management
Non-surgical approaches are always the starting point and remain the backbone of neurogenic bladder management for many patients. Surgery is reserved for cases where these measures are insufficient to protect the kidneys, control infection, or achieve acceptable quality of life.
Clean Intermittent Catheterization (CIC)
CIC is the gold-standard method for bladder emptying in neurogenic bladder. The patient inserts a catheter through the urethra every 4–6 hours to drain the bladder completely, then removes it — no tube remains in place. When performed correctly, CIC dramatically reduces infection risk compared to indwelling catheters, while keeping the bladder empty and pressures low.
CIC requires adequate hand function and patient motivation. For patients who cannot catheterize through the urethra due to anatomy, sensation, or dexterity, a surgically created catheterizable channel (Mitrofanoff) can bring the catheterization site to a more accessible location.
Medications
Anticholinergic medications and beta-3 agonists reduce involuntary bladder contractions and improve storage capacity and compliance. Often used in combination with CIC. Bladder Botox (intradetrusor botulinum toxin) is an effective office-based option for overactive neurogenic bladder refractory to oral medications — reducing contractility for 6–12 months per treatment cycle.
Indwelling Catheter (Urethral or Suprapubic)
A continuously indwelling catheter — either through the urethra (Foley) or through the lower abdominal wall into the bladder (suprapubic tube) — provides continuous drainage without requiring patient participation. The suprapubic tube is generally preferred over urethral catheters for long-term use as it avoids urethral erosion and is easier to manage for patients with limited hand function.
Indwelling catheters carry a higher long-term infection and stone risk than CIC and are generally viewed as a step down from intermittent catheterization. However, for patients who cannot safely perform CIC, they provide reliable, continuous drainage and are an appropriate long-term solution.
Surgical options for neurogenic bladder
Many of the surgical procedures used for neurogenic bladder will be familiar from other conditions on this site — but the purpose and context are different. Here, surgery is often aimed at lowering bladder pressures to protect the kidneys, creating a catheterizable outlet to restore independence, or providing continent drainage when urethral access is not possible or practical.
Bladder Augmentation (Enterocystoplasty)
A segment of intestine is detubularized and sewn into the bladder to increase its capacity and — critically — reduce storage pressure. This is the primary surgical solution for a small, poorly compliant bladder that is causing back-pressure and threatening kidney function. Augmentation protects the upper tracts even when the patient remains incontinent, and is frequently combined with a catheterizable channel to enable reliable emptying.
Patients require lifelong CIC after augmentation and need regular surveillance for mucus production, stone formation, and metabolic changes from the bowel segment.
Catheterizable Channel (Mitrofanoff / Appendicovesicostomy)
A small continent channel is created — typically using the appendix (Mitrofanoff) or a segment of intestine — connecting the bladder to a flush stoma on the abdominal wall, usually at or near the umbilicus. The patient catheterizes through this stoma to empty the bladder, bypassing the urethra entirely.
This is transformative for patients who have difficulty catheterizing urethrally due to anatomy, sensation loss, positioning limitations, or hand function. The abdominal stoma is discreet, continent between catheterizations, and places the access point where the patient can actually reach it. Often combined with bladder augmentation when capacity or compliance is also a problem.
Artificial Urinary Sphincter (AUS)
For neurogenic bladder patients with stress urinary incontinence due to a weak or non-functional sphincter, an AUS can restore continence by placing a mechanical cuff around the urethra. The patient activates a scrotal or labial pump to open the cuff and urinate or catheterize. Requires adequate hand dexterity and a bladder with acceptable storage pressures — bladder augmentation may be needed first if compliance is poor. Dr. Wiegand is an AMS 800 Center of Excellence. Learn more →
Urethral Sling
A sling placed under the urethra to increase outlet resistance and reduce stress leakage. Appropriate for selected neurogenic bladder patients with sphincteric insufficiency and adequate bladder compliance. Simpler than the AUS but less adjustable. Patient selection is important — a sling in a high-pressure bladder without augmentation can worsen upper tract damage.
Urethral Closure
In patients with severe, irreparable urethral incompetence — particularly wheelchair users with pressure injuries or chronic urethral erosion from indwelling catheters — surgical closure of the urethra eliminates leakage entirely. Always combined with an alternative drainage route such as a suprapubic tube, Mitrofanoff channel, or bladder augmentation with catheterizable stoma.
Incontinent Vesicostomy
A small opening is created between the bladder dome and the lower abdominal skin, allowing urine to drain continuously into a diaper or collection device. Most commonly used in young children with neurogenic bladder as a temporary measure — keeping the bladder low-pressure while deferring more complex reconstruction until the child is older. Rarely used as a long-term solution in adults.
Ileal Conduit or Continent Reservoir
When the bladder cannot be salvaged or the entire lower urinary tract is non-functional, urinary diversion creates a new drainage pathway. An ileal conduit (urostomy with external bag) is the most reliable option. For selected patients with good hand function, a continent reservoir (Indiana Pouch) allows catheter-based drainage without an external bag. Learn more about urinary diversion →
These procedures are often combined
Neurogenic bladder reconstruction rarely involves a single procedure. A patient with a small, high-pressure bladder and urethral incompetence might need bladder augmentation, a Mitrofanoff channel, and urethral closure — all in a single operation. Dr. Wiegand will map out the full picture at consultation and explain what combination makes sense for your specific anatomy, function, and goals.
Living with neurogenic bladder?
Effective management can protect your kidneys, reduce infections, and restore independence. Dr. Wiegand offers thorough evaluations and individualized surgical planning.
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