[Neurogenic bladder as a cause of urinary tract infection]

Abstract

Life expectancy and physical fitness of patients with neurogenic bladder dysfunctions is highly dependent on the urine status of the patient, and on the integrity and function of the upper urinary tract. Residual urine and urine incontinence give rise to infections, a vicious circle which ends with uraemia. Following nerve disorders can be the cause of a bladder dysfunction with outflow obstruction thus bearing the risk of ascending urine infection: 1) complete or incomplete spinal cord lesion, 2) myelomeningocele, 3) diseases of the CNS, 4) peripheral neuropathy (diabetes, chronic alcoholism, infectious diseases), 5) effect or side-effect of medications. An infravesical obstruction can occur at the alpha-adrenergic receptor site, at the level of the bladder neck or at the level of the striated external sphincter. The latter condition was termed detrusor-sphincter-dyssynergia. Instrumental bladder emptying for prevention of UTI can be achieved by: 1) catheterisation, 2) intermittent self catheterisation, 3) indwelling catheter--should be avoided for long term drainage, 4) suprapubic bladder drainage (cystocath)--the best treatment option for emptying the bladder and to avoid infections.