Neurologic bladder in neuropathies

Bladder control is ensured by an integrated function of the brain, brainstem, spinal cord, and peripheral nervous system. Various impairments of this function, due to diseases involving one or more organs of the nervous system, may be the cause a neurogenic bladder, via damage of the parasympathetic, sympathetic, or nerve supplytothebladder [1,2,4]. The parasympathetic nerves control detrusor contraction via the nervi ergentes from root 5254 of the spinal cord. The sympathetic source, which innervates the trigone and the internal sphincter, ensures the opening of the bladder neck during the micturition. The pudendal nerve ensures the voluntary control of the striated external sphincter. Damage to the bladder nerve supply is a frequent condition underlying many forms of neuropathy [5, 22]. Neuropathies, also referred to as peripheral neuropathies, present as a form of com Only some neuropathies lead to disorders of the autonomic nervous system and involve various organs or apparatuses. In this chapter, for the sake of completeness and to provide the reader with a broad view for differential diagnosis, we describe synthetically all the types of neuropathies, but we illustrate in detail the neuropathies accompanying the disorders of the autonomic nervous system of the bladder that manifest with the classical symptoms of neuropathic bladder [5, 221. plex syndromes, although a given disease may affect only one nerve (single mononeuropathy) or more nerves in an asymmetric and synchronous manner (polyneuropathies). They are characterized by functional insufficiency of the motor, sensory, and autonomic nervous system, and present as a sensory-motor disorder and, eventually, as disorders of the autonomic system of many organs or apparatuses. Single mononeuropathies generally have a genetic or inflammatory origin; multiple mononeuropathies may have a vascular, metabolic, infectious, or compressive origin; polyneuropathies due variable causes may also 67 be an epiphenomenon of diseases of various etiologies. Many classifications for neuropathies have been proposed; one of the most complete ones is that by Cali and Piore-Donati, which includes hereditary neuropathies, neuropathies of immune origin, toxic neuropathies, neuropathies due to deficiencies, paraneoplastic neuropathies, metabolic neuropathies, infectious neuropathies, ischemic neuropathies, and, lastly, neuropathies due to traumatic injury of the nerves [6, 10, 18, 19, 21]. The classification proposed by Nappo is also quite comprehensive, and includes neuropathies due to physical agents, neuropathies occurring during a systemic disease, poisonous neuropathies, neuropathies due to nutrient deficiency, inflammatory neuropathies, infectious neuropathies, genetic neuropathies, neuropathies in elderly people, and, lastly cryptogenic neuropathies. A simpler classification has been provided by Gaburro and collaborators; it includes inflammatory neuropathies, hereditary neuropathies, toxic neuropathies, and neuropathies due to traumatic injury of the nerve [1, 2, 4]. © 2006 Springer-Verlag Berlin Heidelberg.