Anatomical Aspects of Neurogenic Bladder and the Approach in Its Management: A Narrative Review

Abstract

The contraction of the detrusor muscle causes the urinary bladder and its mass peristaltic movement, leading to micturition. The vesical plexus of nerves, composed of fibers from the inferior hypogastric plexus, supplies the urinary bladder. The brain plays a crucial part in developing and maintaining bladder control, although its specific involvement in urgency and urine leakage is not well understood. The critical components in the neural control of the bladder and its regulation are the pontine micturition center (located in the mediodorsal aspect of the pons) and the Onuf's nucleus, also known as the sacral micturition center (located between the sacral S2 and S4 segments). The most important cause of a neurogenic bladder is damage or lesions of the spinal cord affecting the pontine micturition center, Onuf's nucleus, or damage to the motor neurons between the pontine and the sacral centers of micturition. Neurogenic bladder can be of several types based on the location of the lesions, such as the autonomous bladder, spastic bladder, atonic bladder, and cortical bladder, all were presented with a unique clinical picture. The classical approach to a case of neurogenic bladder involves a complete assessment of the neurologic system and of pelvic anatomy, while neurogenic bladder rehabilitation may include a bladder retraining program involving intermittent catheterization, timed voiding, medications, and lifestyle modifications. This review article attempts to correlate the neurogenic bladder with various anatomical aspects related to the micturition center in the brain and spinal cord and their control over the urinary bladder, as well as the classical approach toward such a case of neurogenic bladder.

Keywords: atonic bladder; autonomous bladder; cortical bladder; neurogenic bladder; onuf's nucleus; pontine micturition centre; spastic bladder.