Neurogenic bladder

　　I. Etiology

　　1. Brain diseases

　　(1) Cerebral vascular diseases:Common conditions include intracranial hemorrhage due to hypertension, atherosclerotic cerebral infarction, cerebral thrombosis, intracranial arteritis, subarachnoid hemorrhage, cerebral vascular malformations and ruptured basilar aneurysm hemorrhage, among which intracranial hemorrhage is the most common. Studies show that the neural pathways controlling the detrusor and external urethral sphincter are almost identical to those支配sensory and motor nerves, and therefore they are often damaged simultaneously. There are many neural nuclei involved in urinary control in the brain, such as the basal ganglia, cerebellum, globus pallidus, corpus striatum, thalamus, etc. When the above neural pathways or nuclei are damaged, patients not only have special consciousness, sensory motor dysfunction, and clinical manifestations of the primary disease, but also often have urinary dysfunction. The types of urinary dysfunction are different due to the site of damage.

　　(2) Parkinson's disease:It is a chronic progressive central nervous dysfunction, manifested by limb tremors, slow body movement, unsteady gait, and齿轮样rigidity of limbs during examination. 25% to 75% of patients have bladder dysfunction, mainly manifested as difficulty in initiating urination, urgency, or urgent urinary incontinence.

　　(3) Brain tumor:When tumors involve the frontal lobe, basal ganglia, or midbrain, urinary dysfunction may occur, so this symptom has certain significance for localization diagnosis. The main symptoms are frequent urination, urgency, and urgent urinary incontinence. In a few cases, difficulty in urination and urinary retention may occur.

　　(4) Multiple sclerosis:It is a chronic progressive central nervous disease, characterized by scattered demyelinating plaques in the brain and spinal cord, causing various neurological symptoms or signs. Early on, about 5% of patients may have bladder dysfunction, while in the late stage, it can reach 90%. It can manifest as frequent urination, urgency, urgent urinary incontinence, and occasionally urinary retention.

　　(5) Senile dementia:Urinary incontinence is the most common symptom of the urinary system, mostly urgent urinary incontinence and loss of consciousness control over urination. The main mechanism is the loss of control by the cerebral cortex over the spinal cord detrusor center.

　　2. Spinal cord lesions

　　(1) Trauma:Spinal cord injury is divided into direct injury, indirect injury, and high-speed projectile injury, among which indirect injury is the most common, such as vertebral fracture, dislocation, or subluxation. The early stage of spinal cord injury is the spinal cord shock period, during which the spinal cord below the injury level loses control over all tissues and organs it支配.

　　(2) Spinal cord disease:Such as spinal tuberculosis, disc herniation, metastatic tumor, cervical spondylosis, and so on.

　　(3) Vascular diseases:Spinal artery embolism can cause damage to the corresponding part of the spinal cord.

　　(4) Neural tube defects:The lumbar sacral region is most common. Large defects can cause cystocele of the spinal cord and meninges, often accompanied by maldevelopment of the spinal cord.

　　(5) Other:Cavum spinalis, poliomyelitis, transverse myelitis, and multiple sclerosis can all lead to dysfunctions of the bladder and urethra.

　　3. Peripheral neuropathy

　　(1) Diabetes:Long-term diabetic patients with impaired glucose metabolism lead to increased vascular resistance in the endoneurium, causing ischemia and hypoxia, resulting in degeneration of nerve cells, axonal dystrophy, and demyelination of nerve fibers. The density of neurons in the bladder wall becomes sparse, with degenerative changes in axons and nerve fragments, and conduction disorders in the传入 and 传出 fibers of the bladder, leading to dysfunctions of the bladder and urethra. Bladder dysfunction is one of the common complications in diabetic patients, with an incidence rate of 43% to 87% in type 1 diabetic patients.

　　(2) Postoperative resection of pelvic organs:For example, after radical rectal cancer surgery, radical hysterectomy, and other radical surgeries, urinary abnormalities often occur postoperatively, with an incidence rate as high as 7.7% to 68%. It has now been confirmed that this is due to injury to the pelvic parasympathetic nerve, sympathetic nerve, pelvic ganglion, and pudendal nerve caused by surgery.

　　(3) Varicella:The varicella-zoster virus潜伏 in the posterior horn cells of the spinal cord and spreads along the nerve sheath, destroying nerves. When it involves the lumbar or sacral nerves, urinary frequency and retention may occur.

　　There are many methods for classifying neurogenic bladder. The commonly used classification method in the past was the Bors classification method, which classified the following 5 categories:

　　1. Upper motor neuron lesion The lesion is above the spinal cord center (S2～S4), including sensory branches and motor branches.

　　2. Lower motor neuron lesion The lesion is located in the spinal cord center (S2～S4) or below the central peripheral nerve, including sensory branches and motor branches.

　　3. Primary motor neuron lesion The lesion is limited to motor branches, and there is no lesion in sensory branches, such as poliomyelitis.

　　4. Primary sensory neuron lesion The lesion is limited to sensory branches. Motor neuron lesion, such as diabetic neuropathy and neurogenic bladder caused by tabes dorsalis.

　　5. 'Mixed' lesions related to urinary autonomic motor neuron lesions (parasympathetic nerve) and somatic motor neuron lesions are not at the same level. One is in the upper motor neuron, and the other is in the lower motor neuron, or one has a lesion and the other does not.

　　Although this classification method is detailed, it is too complex and lacks guidance for the selection of treatment methods. In recent years, internationally, according to whether there is an uninhibited contraction of the detrusor muscle during bladder filling, it is divided into two categories:

　　1. Detrusor hyperreflexia The detrusor muscle has a hyperreflexive response to stimulation, and there is an uninhibited contraction when measuring bladder pressure. It may be accompanied by or without dysfunction of the urethral sphincter.

　　2. Detrusor areflexia In this type of neurogenic bladder, the detrusor muscle does not have a reflex or has a reduced reflex to stimulation. There is no uninhibited contraction when measuring bladder pressure. It may be accompanied by or without dysfunction of the urethral sphincter.

　　Second, pathogenesis

　　Pathophysically, neurogenic bladder is divided into detrusor hyperreflexia and detrusor areflexia. Detrusor instability (DI), detrusor hyperreflexia (DHR), and reduced bladder compliance are the three main types of detrusor hyperactivity, and the sphincter may show normal coordination, external sphincter dyssynergia, or internal sphincter dyssynergia. Detrusor areflexia (DVA) is common in patients with neurological diseases, and bladder outlet obstruction (BOO) caused by hyperactivity of the sphincter during micturition is also common, and it is difficult to differentiate the comprehensive symptoms of male DVA patients from those of BOO patients. This is because DVA may be accompanied by normal sphincter coordination, external sphincter spasm, denervation of the external sphincter, and internal sphincter spasm.

　　There are many methods for classifying neurogenic bladder and urethral dysfunction:

　　1. The Hald-Bradley classification method reflects functional changes based on the site of the lesion:

　　(1) Lesions above the spinal cord have coordinated detrusor contraction and urethral sphincter relaxation, with most cases having detrusor reflex hyperactivity and normal sensory function.

　　(2) Lesions above the sacral cord mostly have detrusor reflex hyperactivity, with dyssynergia between the detrusor and urethral sphincter, and sensory function is related to the extent of nerve damage, which can be partial or complete loss.

　　(3) Lesions below the sacral cord include the传入 and传出 nerve lesions of the sacral cord. Due to the damage to the detrusor motor nerve, detrusor areflexia can occur, and sensory nerve damage can lead to the loss of sensory function.

　　(4) Peripheral autonomic neuropathy is mostly seen in diabetic patients, characterized by incomplete bladder sensory function, increased residual urine volume, and finally, compensatory failure, with weak detrusor contraction.

　　(5) Muscle lesions can include the detrusor itself, smooth muscle sphincter, all or part of striated muscle sphincter. Detrusor dysfunction is the most common, often secondary to compensatory failure after long-term bladder outlet obstruction.

　　2. The Lapides classification method classifies according to the changes in sensory and motor functions after nerve damage:

　　(1) Sensory disturbance neurogenic bladder:Caused by the obstruction of sensory fiber conduction between the bladder and spinal cord or between the spinal cord and brain. It is more common in diabetes, dysmetria, malignant anemia, etc. Urinary dynamics show a large bladder capacity, high compliance, and low-pressure filling curve, with a possibility of a large amount of residual urine.

　　(2) Motor paralytic bladder:Caused by the damage to the parasympathetic motor nerve of the bladder. Common causes include pelvic surgery or injury. Early symptoms include difficulty in urination, painful urinary retention, etc. Cystometry shows that bladder filling can be normal, but it is difficult to initiate autonomous bladder contraction when reaching the maximum bladder capacity. Later symptoms include changes in bladder sensory function and a large amount of residual urine, with cystometry showing increased bladder capacity, high compliance, and inability to initiate detrusor contraction.

　　(3) Non-inhibitory neurogenic bladder:It is due to the destruction of nerve centers or nerve conduction fibers that can inhibit the sacral micturition center, resulting in the loss of inhibitory effect on the sacral micturition center. It is common in cerebrovascular diseases, brain or spinal cord tumors, Parkinson's disease, demyelinating diseases, etc. Most cases manifest as frequent urination, urgency, and urgent incontinence, with urinary dynamics showing involuntary bladder contraction during storage, the ability to autonomously initiate detrusor contraction for urination, and generally no difficulty in urination and no residual urine.

　　(4) Reflex neurogenic bladder:Originating from the complete sensory and motor pathway damage between the sacral cord and brainstem. It is most common in traumatic spinal cord injury and transverse myelitis, and can also occur in demyelinating diseases, as well as any process that may cause significant spinal cord injury. The typical manifestation is the loss of bladder sensation, the loss of the ability to autonomously initiate contraction, but spontaneous detrusor contractions can occur during bladder filling, with dyssynergia between the detrusor and sphincter muscles.

　　(5) Autonomous neurogenic bladder:It is due to the damage of the sacral cord, sacral nerve root, or pelvic nerve, resulting in the complete separation of sensory and motor functions of the bladder. The patient cannot initiate urination autonomously, and there is no bladder reflex activity. Cystometry shows no autonomous or spontaneous detrusor contraction, with low bladder pressure and increased capacity.

　　3. The Krane-Siroky classification method classifies according to the abnormalities shown by urodynamic examination.

　　(1) Detrusor hyperreflexia:The spontaneous or induced contraction of the detrusor muscle during the storage period is called detrusor instability. If combined with central nervous system abnormalities, it is called detrusor hyperreflexia. The diagnostic criteria are the appearance of involuntary detrusor contractions with an amplitude exceeding 1.47 kPa (15 cmH2O) during the storage period. It is divided into the following subtypes: ① Coordination of the sphincter is normal: Refers to the coordinated relaxation of the urethral sphincter during detrusor contraction for urination. ② External sphincter coordination disorder: Refers to the external urethral sphincter still being in a state of contraction during detrusor contraction for urination, leading to incomplete opening of the urethra. ③ Internal sphincter coordination disorder: Refers to the urethral internal sphincter not relaxing during detrusor contraction for urination.

　　(2) Detrusor areflexia:It refers to the inability of the detrusor muscle to contract or contract weakly during micturition. It can be further divided into the following subtypes:

　　① Coordination of the sphincter is normal:It refers to the coordinated relaxation of the urethral sphincter during urination.

　　② Spasm or dyskinesia of the external sphincter:It is manifested as the external urethral sphincter being in a state of continuous contraction during urination.

　　③ Spasm or dyskinesia of the internal sphincter:It is manifested as the non-opening of the internal orifice of the urethra during urination.

　　④ Denervation of the external sphincter:It refers to muscle atrophy and relaxation of the external urethral sphincter and pelvic floor muscles after losing neural control, causing bladder and urethra prolapse and urethral angulation, resulting in difficulty in urination.

　　Urothelial infection is the most common complication of neurogenic bladder, and 10% to 15% of patients may develop urinary tract stones. Bladder-ureteral reflux occurs in 10% to 40% of patients with neurogenic bladder, usually reversible. It may improve spontaneously when urination improves, residual urine decreases, and bladder pressure decreases. It may also be complicated by pyelonephritis, renal failure, hydronephrosis, and renal function decline.

　　In fact, almost all lesions of the nervous system can affect bladder function. The nervous system that controls bladder function includes various neural tissues, both central and peripheral. Therefore, if any part of the neural tissue is damaged, it may affect bladder function, such as stroke, Parkinson's disease, multiple sclerosis, diabetes, spinal cord herniation, spinal cord injury or surgery, pelvic trauma or surgery, and so on, which may affect bladder function.

　　In addition, the degeneration of nerve function caused by poor urinary habits, organ aging, inflammation, or anxiety and other factors will affect bladder function and cause neurogenic bladder.

　　Therefore, preventing nerve injury and preventing the degeneration of nerve function are possible methods to prevent neurogenic bladder.

　　A series of imaging examinations, such as intravenous urography (excretory urography), ultrasound, cystography, and urethrogram, are helpful to evaluate the secondary damage and disease progression of neurogenic bladder, and can show urinary tract stones. Cystoscopy can determine the degree of bladder outflow obstruction. Serial bladder pressure tracing examinations during the recovery period of hypotonic bladder can provide the detrusor function index, indicating the prospect of recovery. Urodynamic measurements of urine flow rate, electromyography of the sphincter muscles, and urethral pressure measurements are all helpful for diagnosis. Urine tests in patients with urinary tract infections may show red blood cells, white blood cells, and positive urine culture.

　　1, Ice Water Test:If there is an injury above the spinal cord center, ice water will be forcefully ejected into the bladder within a few seconds after injecting ice water into the bladder; if there is an injury below the spinal cord center, there will be no such reaction.

　　2, Urodynamic examination:It can reflect the hyperactivity of detrusor reflex or absence of detrusor reflex and the function of urethral sphincter muscle.

　　3, Excretory cystography:It can be seen that the bladder wall has small trabeculae formation, diverticula, and typical 'Christmas tree' shaped bladder. Dynamic observation shows abnormal contraction of the detrusor muscle, abnormal coordination between the detrusor muscle contraction and the external and internal sphincter muscles of the urethra, and increased residual urine.

　　Neurogenic bladder dietary recipe:

　　1, Corn Porridge

　　Ingredients: Corn bran 50 grams, a little salt.

　　Preparation and usage: Cook corn bran with an appropriate amount of water into porridge, then add a little salt and it is ready. Eat on an empty stomach.

　　2, Barley Porridge

　　Ingredients: Barley rice 50 grams, an appropriate amount of brown sugar.

　　Preparation and usage: Grind the barley rice, boil it into porridge with water, then add an appropriate amount of brown sugar and mix well before eating.

　　3, Bamboo Leaf Porridge

　　Ingredients: Fresh bamboo leaves 30-45 grams, gypsum 15-30 grams, glutinous rice 50-100 grams, a little sugar.

　　The main protection of kidney function in the treatment of neurogenic bladder is to prevent renal pelvis nephritis, renal pelvis calculus, and hydronephrosis leading to chronic renal insufficiency; the next is to improve urinary symptoms to alleviate the pain in daily life. The specific measures for treatment are to adopt various non-surgical or surgical methods to reduce the residual urine volume. After the residual urine volume is eliminated or reduced to a very small amount (less than 50ml), the complications of the urinary tract can be reduced. However, it must be noted that a few patients, even though the residual volume is very small or even completely absent, may still experience complications such as renal pelvis hydronephrosis, pyelonephritis, and renal function decline. These patients should be treated early to relieve lower urinary tract obstruction, as they have a strong detrusor contraction during urination, and the intravesical pressure can reach above 19.72kPa (200cmH2O), which is normal below 6.9kPa (7cmH2O).

　　First, non-surgical treatment

　　1. Catheterization:Whether for the purpose of promoting storage or urination, intermittent catheterization can effectively treat neurogenic and muscular urinary dysfunction, alleviating the pain of long-term catheterization or suprapubic cystostomy, and creating conditions for further treatment (bladder augmentation,可控性尿流改道术). Years of clinical observation have proven its safety and effectiveness in long-term use. Initially, instruct patients to catheterize every 4 hours, and then control the specific interval time according to their own situation, with the principle of not causing incontinence and not overfilling the bladder. Practice has shown that symptomatic infection is not common. Indwelling catheter or cystostomy is generally used for a short period of time, but for some patients, regular replacement of catheters for long-term bladder drainage is the only feasible method.

　　2. Auxiliary treatment:(1) Timely bladder emptying, especially for patients with detrusor hyperreflexia. Instruct patients to urinate every 3-4 hours, regardless of whether they have urgency. Drug therapy is often used in conjunction with timed urination. (2) Pelvic floor muscle training, perineal area electrical stimulation is commonly used as an auxiliary treatment for female stress urinary incontinence to increase bladder outlet resistance. (3) Training 'trigger point' urination, using Crede technique for urination can increase intravesical pressure and contraction, promoting bladder emptying, but for some cases of low compliance bladder with reflux, Crede technique may exacerbate renal function damage. (4) For some male patients, penile clamps or condom urine collection devices and other external urine collection devices can be used.

　　3. Drug therapy:

　　(1) Bladder contraction inhibiting drugs: Clinically, more than one drug with different pharmacological mechanisms is commonly used to treat detrusor involuntary contractions. 1) Anticholinergic: Propantheline, 15-30mg per dose for adults, once every 6 hours, taken on an empty stomach, the most commonly used in clinical practice; Atropine has 'tolerance', and can only partially inhibit detrusor contraction of the bladder. This class of drugs can cause dry mouth, tachycardia, blurred vision, reduced peristalsis, and in high doses, can cause hypotension and erectile dysfunction. It is contraindicated in patients with severe bladder outlet obstruction and glaucoma. 2) Smooth muscle relaxants: Flavoxate (Nifural) is most commonly used in clinical practice, 0.1-0.2g per dose for adults, three times a day, effective for patients with urgency, incontinence, and detrusor hyperreflexia in urodynamic performance, with few side effects. 3) Calcium channel blockers: Such as nifedipine, 10mg per dose, three times a day. Certain tricyclic antidepressants, β-adrenergic agonists, and other drugs are also used in clinical practice.

　　(2) Drugs to promote bladder urination: 1) Parasympathomimetic drugs: Carbachol, 7.5mg/time, 1 time every 4 to 6 hours, subcutaneous injection, with good clinical efficacy in the treatment of high-compliance bladder, and better effects when combined with manual urination. 2) α-adrenergic antagonists: such as Tamsulosin, Terazosin, etc., which can reduce bladder outlet resistance.

　　(3) Drugs to increase bladder outlet resistance: 1) α-adrenergic drugs: such as Ephedrine, 25mg/time, 4 times/d; Imipramine 25mg/time, 1 time/night, with definite efficacy. Contraindicated in patients with hyperthyroidism, and used with caution in cardiovascular diseases. 2) α-adrenergic antagonists: such as Propranolol 10mg/time, 4 times/d, effective for some patients, contraindicated in asthmatic patients. 3) For postmenopausal women, estrogens can increase urethral resistance, such as Nylestriol tablets 1mg/time, 1 time every 2 weeks.

　　(4) Drugs to reduce bladder outlet resistance: Commonly used highly selective α1 receptor blockers such as Terazosin, Tamsulosin, etc. Prazosin is an α1 receptor blocker, and α1 receptors can be divided into high-affinity α1H receptors and low-affinity α1L receptors. α1H receptors can be further divided into α1A, α1B, α1C, and α1D four subtypes. Terazosin (2mg/time, 1 time/night) belongs to the type mainly composed of α1H receptor blockers, and Tamsulosin (0.2mg/time, 1 time/night) is an α1A receptor blocker. Clinical experience shows that the efficacy and symptom relief of the former are better than those of the latter, but the latter almost does not appear with orthostatic hypotension and other side effects, also known as the 'first-dose phenomenon'.

　　4、针炙疗法：Acupuncturetherapyhasagoodeffectonbladderparalysisduetodiabetesmellitus,especiallynotableinearlylesions.

　　5、封闭疗法：ThismethodwasproposedbyBorsandisapplicabletouppermotorneuronelesions(reflexhyperactivityofthebladdermuscle).Itisnotveryeffectiveforlesionsofmotorneurons(reflexinactivityofthebladdermuscle).Afterblockade,goodresultsindicateasignificantreductioninresidualurinevolumeandimprovementinvoidingsymptoms. A few patients, after one block, can maintain the effect for several months to one year. These patients only need regular treatment and do not require surgery.

　　The封闭therapyiscarriedoutinthefollowingorder:(1)Mucosalblockade:Emptythebladderwithaurethralcatheter,inject90mlof0.25％Pantocaine,drainafter10to20minutes.(2) Bilateral pudendal nerve block.(3) Selective sacral nerve block: Block a pair of sacral nerves from S2 to S4 each time. If there is no effect, S2 and S4 can be combined blocked.

　　6. Bladder training and expansion:For patients with severe symptoms of frequent urination and urgency, with no residual urine or very little residual urine, this method can be used for treatment. Instruct patients to drink water at regular intervals during the day, 200ml per hour. Try to extend the interval between urination as much as possible, so that the bladder can gradually expand easily.

　　Second, surgical treatment

　　Its function is to improve bladder compliance and capacity, and change the resistance of the bladder outlet. It should be performed after non-surgical treatment has been proven ineffective and after the neurologic changes have stabilized. Patients with lower urinary tract mechanical obstruction should consider removing the obstructive factors first.

　　Surgical principles

　　(1) For patients with mechanical obstruction of the urinary system (such as benign prostatic hyperplasia), the mechanical obstruction should be removed first. (2) For patients with detrusor areflexia, transurethral bladder neck incision should be considered first. (3) For patients with detrusor reflex hyperactivity or detrusor-sphincter functional dyssynergia, if pudendal nerve block has only transient effects, transurethral external sphincterotomy or resection can be performed. (4) For patients with detrusor reflex hyperactivity, if selective sacral nerve block has only transient effects, corresponding sacral nerve alcohol injection or sacral nerve root section can be performed. (5) For patients with severe symptoms of frequent urination and urgency (urgent urinary syndrome), with no residual urine or very little residual urine, and no effect from medication, closed treatment, bladder training, and expansion, consider bladder nerve resection or injection of anhydrous alcohol or 6% carbonic acid into the lateral sides of the pelvic nerves under cystoscopy. (6) For patients with detrusor reflex hyperactivity, if all kinds of closed treatments are ineffective, bladder neck incision should be performed. (7) Full-length posterior urethral incision: This operation is only suitable for males, causing the patient's urethral internal sphincter to lose control over the outflow of bladder urine, resulting in resistance-free urinary incontinence and smooth urine outflow. The patient needs to collect urine with a condom and a urinary collection bag for life. After this operation, complications such as urinary tract infection are reduced to less than 1%. The disadvantage is that the patient is less convenient in daily life.

　　1. Surgery to reduce bladder outlet resistance:(1) Transurethral bladder neck incision or partial resection is the most important surgical method for treating bladder neck obstruction and bladder-urethral functional abnormalities, suitable for patients with sufficient bladder capacity, good detrusor contraction, and proximal urethral pressure distribution showing sphincter pressure ≥ detrusor pressure. The key point of the operation is to incise the range near the seminal colliculus. For refractory cases with multiple surgical failures, it is generally necessary to use an external urinary collection device after external sphincterotomy. (2) Bladder neck Y-V plasty is suitable for patients with detrusor hyperactivity, considerable residual urine, ineffective closed treatment, or the need to simultaneously treat bladder lesions. (3) For female patients, the efficacy of over-urethral extension (F40～F50) is good, this method is simple to operate, can be repeated, and has good urinary control. (4) Botulinum toxin A injection into the external sphincter has certain practical value, and the efficacy can last for more than 1 month. (5) Other surgical methods, such as pudendal nerve section, sacral nerve root section, and even urinary diversion, are now rarely used due to severe and frequent complications; similarly, external sphincterotomy should also be avoided, and intermittent self-catheterization should be preferred.

　　2. Surgical methods to increase bladder outlet resistance:(1) Intravesical periurethral injection, although it is less effective for male urinary incontinence than for female, it should be the first choice for treating urinary incontinence due to its simplicity, safety, and few complications. (2) Cysto-urethral suspension, a classic method to increase bladder outlet resistance, has many surgical techniques, is effective, and is often used to treat female stress urinary incontinence. (3) Fascial suspension, using the perineal muscles of the anterior sheath of the rectus abdominis and other muscles to compress the bulbous urethra or surround the posterior urethra, is suitable for incomplete sphincter function or severe female stress urinary incontinence. (4) Other surgical methods, such as bladder outlet reconstruction, are mainly used to treat urinary incontinence caused by incomplete bladder outlet closure; inflatable artificial urinary sphincters are less commonly used in clinical practice due to many complications and high cost.

　　3. Surgical methods to increase bladder compliance and nutrition:The most commonly used procedure is bladder augmentation, with an efficacy rate of over 80%. It plays an important role in treating refractory voiding dysfunction and reconstructing lower urinary tract function. Intermittent catheterization or short-term indwelling catheterization can significantly relieve certain degrees of bladder emptying obstruction in some patients.

　　3. Treatment of Complications

　　The main complications of neurogenic bladder include urinary tract infections, stones, urethral diverticula, vesicoureteral reflux, and others. They can be treated with anti-infection, extracorporeal shock wave lithotripsy, or surgical incision and stone removal, and various forms of anti-reflux surgery.