What complications are associated with bladder dysfunction?

Updated: Jan 04, 2019
  • Author: Gregory T Carter, MD, MS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Bladder dysfunction harbors complications associated with urine retention as well as incontinence. Complications of incontinence are infective in nature and include cystitis and pyelonephritis. Complications associated with urine retention include vesicoureteral reflux and renal calculi. For those patients who benefit from the use of indwelling catheters, increased risk of cystic cancer is a complication.

Urinary tract infections are a frequent cause of morbidity in patients with neurogenic bladder, because patients who lack sensation do not experience dysuria. Instead, symptoms may include fever, tachycardia, a feeling of uneasiness, signs and symptoms of autonomic dysreflexia, malodorous urine, increase in spasticity (in patients with upper motor neuron lesions), and lethargy.

Bladder infections are the most common complication of neurogenic bladder. The use of prophylactic antibiotics in patients on long-term intermittent catheterization is still controversial. Avoid use of prophylactic antibiotics in patients with indwelling Foley catheters.

A Korean study, by Sung et al, indicated that the risk of chronic kidney disease (CKD) is three times higher in patients with neurogenic bladder. The prevalence of CKD in these patients was reported to be 8.0% and 22.4%, as measured using serum creatinine– and serum cystatin-c–based estimated glomerular filtration rate, respectively. [13]

The chief concern with urinary tract infection is that if left untreated, it may lead to urosepsis or pyelonephritis. [14, 15] Pyelonephritis is also associated with reflux, kidney stones, and obstruction and can lead to renal deterioration.

Vesicoureteral reflux is associated with renal deterioration, especially in the presence of recurrent infection. Most deaths from renal complications in patients with neurogenic bladder are secondary to reflux.

Kidney stones are the leading cause of renal dysfunction in SCI, with approximately 8% of SCI patients developing renal calculi in the form of kidney and bladder stones. [16] The highest incidence (up to 8%) is in those patients with indwelling catheters. Bladder stones are associated with indwelling Foley catheters. Struvite stones and calcium phosphate make up more than 90% of cases of stone formation. Nephrolithiasis is also an indicator for renal deterioration.

The prevalence of bladder cancer is higher in SCI patients who have had an indwelling Foley catheter for 10 years or more than in other patients with SCI or in the general population. Squamous cell carcinoma and transitional cell carcinomas are the types of bladder cancer commonly diagnosed in SCI patients. [17]


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