Neurogenic bladder

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Neurogenic bladder



Neurogenic bladder


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USMLE® Step 1 questions

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High Yield Notes

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Neurogenic bladder

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USMLE® Step 1 style questions USMLE

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A 75 year-old African-American male comes to the office because of continuous dribbling of urine which began one month ago. In addition, the patient endorses difficulty initiating and maintaining a urinary stream. Past medical records indicate that he has hypertension and type 2 diabetes mellitus. The patient has a 40-pack-year smoking history. His temperature is 37.0°C (98.6°F), blood pressure is 150/86 mmHg, pulse is 70/min, and respirations are 15/min. Cardiac, pulmonary, and abdominal examinations are non-contributory. Digital rectal exam reveals an enlarged, symmetrical, and smooth prostate. Laboratory study results are as follows:  
 Laboratory value  Result 
 Glucose  118 mg/dL 
 HbA1c  6.9% 
 Prostate-specific antigen (PSA)*  3.6 ng/ml 
*Normal PSA < 4.0 ng/ml

Which of the following is the most likely cause of the patient’s urinary symptoms?

External References

First Aid






Neurogenic bladder p. 541, 624


Content Reviewers

With neurogenic bladder, neurogenic means arising from the nervous system, so neurogenic bladder is typically some difficulty emptying the bladder normally, as a result of either damage to the peripheral nerves, brain, or spinal cord.

Normally, urine is held in the bladder, which receives urine from two ureters coming down from the kidneys and then that urine leaves the bladder through the urethra.

As urine flows from the kidney, through the ureters and into the bladder, the bladder starts to expand into the abdomen. The bladder is able to expand and contract because it’s wrapped in a muscular layer, called the detrusor muscle, and within that, lining the bladder itself is a layer of transitional epithelium containing “umbrella cells”. These umbrella cells get their name because they physically stretch out as the bladder fills, just like an umbrella opening in slow-motion.

In a grown adult, the bladder can expand to hold about 750ml, slightly less in women than men because the uterus takes up space which crowds out the bladder a bit.

Okay - so when the urine is collecting in the bladder, there are basically two “doors” that are shut, holding that urine in. The first door is the internal sphincter muscle, which is made of smooth muscle and is under involuntary control, meaning that it opens and closes automatically. Typically, the internal sphincter muscle opens up when the bladder is about half full.


Neurogenic bladder is a type of bladder dysfunction that is caused by damage to the nerves related to the bladder control. It is characterized by difficulty emptying the bladder normally, as a result of either damage to the peripheral nerves, brain, or spinal cord.

Neurogenic bladder can occur as a result of various conditions, such as spinal cord injuries, multiple sclerosis, and diabetes. Related bladder dysfunctions could be overflow incontinence, where the bladder fills up to capacity and then dribbles out of the urethra, or urge incontinence, where an individual feels frequent urges to urinate.


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