Neurogenic Bladder
Neurogenic Bladder
Merck Manuals Online Library
Diagnosis
* Postvoid residual volume
* Renal ultrasonography
* Serum creatinine
* Usually cystography, cystoscopy, and cystometrography with urodynamic testing
Diagnosis is suspected clinically. Usually, postvoid residual volume is measured, renal ultrasonography is done to detect hydronephrosis, and serum creatinine is measured to assess renal function. Further studies are often not obtained in patients who are not able to self-catheterize or ask to go to the bathroom (eg, severely debilitated elderly or post-stroke patients). In patients with hydronephrosis or nephropathy who are not severely debilitated, cystography, cystoscopy, and cystometrography with urodynamic testing are usually recommended and may guide further therapy. Cystography is used to evaluate bladder capacity and detect reflux. Cystoscopy is used to evaluate duration and severity of retention (by detecting bladder trabeculations) and to check for bladder outlet obstruction. Cystometrography can determine whether bladder volume and pressure are high or low; if done during the recovery phase of flaccid bladder after spinal cord injury, it can help evaluate detrusor functional capacity and predict rehabilitation prospects (see Voiding Disorders: Testing). Urodynamic testing of voiding flow rates with sphincter electromyography can show whether bladder contraction and sphincter relaxation are coordinated (see Voiding Disorders: Testing).
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