Neurogenic detrusor overactivity

Neurogenic Detrusor Overactivity (NDO) is a urological condition characterized by involuntary contractions of the bladder muscle, known as the detrusor, during the filling phase, which can lead to symptoms such as increased frequency and urgency of urination, and incontinence. NDO is specifically caused by neurological abnormalities or injuries that disrupt the normal control of bladder contractions. Common neurological conditions associated with NDO include Spinal cord injury, Multiple sclerosis, and Parkinson's disease.

Causes and Pathophysiology

Neurogenic Detrusor Overactivity results from the miscommunication between the central nervous system (CNS) and the nerves controlling the bladder due to damage or dysfunction in the neurological pathways. This miscommunication can lead to uncoordinated bladder contractions during the filling phase, when the bladder should be relaxed. The exact mechanism can vary depending on the underlying neurological condition but generally involves disruption of the inhibitory signals that normally prevent involuntary bladder contractions.

Symptoms

The primary symptoms of NDO include:

• Urgency: A sudden, compelling need to pass urine
• Frequency: Needing to urinate more often than usual
• Nocturia: Frequent urination at night
• Urinary incontinence: Involuntary leakage of urine

These symptoms can significantly impact the quality of life, leading to social, psychological, and hygiene issues.

Diagnosis

Diagnosis of NDO involves a combination of patient history, physical examination, and diagnostic tests. Key diagnostic tests include:

• Urodynamic testing: Measures the pressure and volume inside the bladder to assess its function and behavior during filling and emptying.
• Urinalysis: Checks for infections or other conditions that could cause similar symptoms.
• Neurological examination: Identifies any underlying neurological disorders.

Treatment

Treatment of NDO aims to manage symptoms and may include:

• Anticholinergic drugs: Medications that help relax the bladder muscle and increase bladder capacity.
• Beta-3 adrenergic agonists: A newer class of medication that relaxes the bladder muscle without the side effects of anticholinergics.
• Botulinum toxin injections: Injected directly into the bladder muscle, reducing the frequency and severity of involuntary contractions.
• Neuromodulation therapies: Such as sacral nerve stimulation (SNS) or percutaneous tibial nerve stimulation (PTNS), which modulate the neural pathways controlling bladder function.
• Catheterization: Either intermittent or continuous, to manage bladder emptying in cases where other treatments are not effective or suitable.

Prognosis

The prognosis for individuals with NDO varies depending on the underlying neurological condition and the effectiveness of treatment. While symptoms can often be managed effectively with treatment, ongoing management may be required to maintain bladder health and prevent complications.

See Also

• Urinary incontinence
• Overactive bladder
• Spinal cord injury
• Multiple sclerosis
• Parkinson's disease