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Late Effects

Renal and Genito-Urinary

 

Neurogenic Bladder

 

The bladder can no longer function properly if its nerve supply is damaged (neurogenic bladder).

Nerve injury causes:

  • Impaired bladder storage
  • Inability to void and/or incontinence

Nerve injury can be at the level of the:

  • Brain
  • Spinal cord
  • Peripheral nerves

Damage can be due to:

  • Tumor growth (causing pressure or normal tissue erosion)
  • Surgery
  • Radiation Therapy (RT)

 

The effect on bladder function depends on the level of the
injury:

Brain tumors:

  • Produce centrally mediated bladder dysfunction
    • Urinary incontinence
    • Loss of inhibition of the bladder and the patient is unable to prevent voiding
    • Associated with:
      • Detrusor over-activity
      • Uninhibited bladder contractions
  • Lesions above the pons do not affect the voiding reflex


Spinal cord injury (SCI)

This can be complete or incomplete

Complete Injury:

  • Bladder and external sphincter disconnected from central control and inhibition
  • Decentralization of the bladder causes detrusor over-activity and poor storage of urine
  • Acutely: Usually a period of spinal shock with detrusor underactivity or areflexia and impairment of bladder emptying
  • When bladder contractility returns there is discoordination between the bladder and the external sphincter leading to high voiding pressures
  • Untreated elevated bladder pressures lead to hydronephrosis and deterioration of renal function

 

Peripheral nerve damage:

  • The usual cause is extensive pelvic surgery during resection of a pelvic tumor (but can occur as a consequence of less radical surgery such as ureteral reimplantation)
  • Causes impaired bladder contractility
  • Bladder storage affected if there is complete denervation, much like that noted with
    SCI
  • High doses of RT (>50 Gy) to the lumbar or sacral spine or to the cauda equina may also cause nerve damage that results in neurogenic bladder

 


 

 

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