Neurogenic Bladder: Urine Retention
What are the treatments for urine retention?
Urine retention may occur either because the bladder wall muscle cannot contract or because the sphincter muscle cannot relax.
Catheter. A catheter is a thin tube that can be slid through the urethra into the bladder to let urine flow out into a collection bag. If you are able to place the catheter yourself, you can learn to carry out the procedure at regular intervals, a practice called clean intermittent catheterization (CIC). Some patients cannot place their own catheters because nerve damage affects their hand coordination as well as their voiding function. These patients need to have a caregiver place the catheter for them at regular intervals. If this is not feasible, the patients may need to have an indwelling catheter that can be changed less often. Indwelling catheters have several risks, including infection, bladder stones, and bladder tumors. However, if the bladder cannot be emptied any other way, then the catheter is the only way to stop the buildup of urine in the bladder that can damage the kidneys.
Urethral stent. Stents are small tube-like devices inserted into the urethra and allowed to expand, like a spring, widening the opening for urine to flow out. Stents can help prevent urine backup when the bladder wall and sphincter contract at the same time because of improper nerve signals. However, stents can cause problems if they move or lead to infection.
Surgery. Men may consider a surgery that removes the external sphincter (sphincterotomy) or a piece of it (sphincter resection) to prevent urinary retention. The surgeon will pass a thin instrument through the urethra to deliver electrical or laser energy that burns away sphincter tissue. Possible complications include bleeding that requires a transfusion and rarely problems with erections. This procedure causes loss of urine control and requires the patient to collect urine by wearing an external catheter that fits over the penis like a condom. No external collection device is available for women.
Urinary diversion. If other treatments fail and urine regularly backs up and damages the kidneys, the doctor may recommend a urinary diversion, a procedure that may require an outside collection bag attached to a stoma, a surgically created opening where urine passes out of the body. Another form of urinary diversion replaces the bladder with a continent urinary reservoir, an internal pouch made from sections of the bowel or other tissue. This method allows the person to store urine inside the body until a catheter is used to empty it through a stoma.
Hope Through Research
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has many research programs aimed at finding treatments for urinary disorders, including bladder control problems caused by nerve damage. NIDDK-supported researchers have narrowed the search for a gene that causes neurological problems in bladder, bowel, and facial muscles. Finding the gene may lead to greater understanding of how nerves and muscles work together and how nerve damage can cause urination problems.
NIDDK is supporting another team of researchers that is testing an injectable form of oxybutynin, a drug for overactive bladder currently available in pill and patch form. Injections may deliver a more effective and efficient dose of oxybutynin because the drug would not be broken down by the digestive system as the oral form is.
The National Institute of Child Health and Human Development is supporting Collaborative Urological Research in Spinal Cord Injury, a program devoted to finding novel strategies to treat bladder control problems in people with spinal cord injury.
Adapted and excerpted from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
Reviewed by Francine Kaufman, MD. 01/09
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