required for emergency treatment. Pretreatment

Metabolic Neuropathies

or chronic administration of sublingual nife-

dipine prior to a procedure or oral terazosin is

Diabetes mellitus can cause an autonomic neu-

used for recurrent AD.

ropathy characterized by loss of autonomic

fibers and rarely degeneration of spinal centers.

Transverse Myelitis

UI is more common in diabetics than in nondia-

betics.46 Urinary frequency may be due to DO or

Transverse myelitis is an immune disorder that

to glucosuria. Diabetic

demonstrates reduced

injures the spinal cord. It can be idiopathic or

bladder sensation with a large capacity bladder

occur as a sequelae of MS or lupus. It is an acute

and residual urine.47 UDS more often reveals

disorder associated with bladder dysfunction in

DO, possibly due to early axonopathy or changes

80–94% of patients.42,43 DO and DSD are com-

in the detrusor. However in the older patient,

mon urodynamic findings. Small studies in chil-

coexistent pathology such as BPH or ischemic

dren document significant recovery from either

brain disease may cause DO in diabetics.

retention or urge UI. In adults, numerous small

Sarcoidosis may involve the central or periph-

case series highlight difficulties with refractory

eral nervous system. Neurogenic bladder is rare

urge UI and residual urines. Approximately a

although DO has been associated with brain

third of patients recover with no ill effects.44

lesions, DSD with spinal intramedullary lesions,

Prognostic information gained from MRI find-

and DA with subarachnoid granulomas and

ings or cytokine measures are reported.

Alcoholic and porphyria-induced peripheral

Peripheral Neuropathies

neuropathy can lead to bladder dysfunction.

Findings mirror diabetic cystopathy.

Infections/Autoimmune Peripheral

Neuropathies

Extensive pelvic surgery can injure the pelvic

Herpes viruses especially varicella-zoster and

plexus,pudendal,pelvic,and hypogastric nerves.

herpes simplex type 2 can cause neuropathic

Historically, the incidence of voiding disorders

bladder. Urinary retention occurs in up to 3.5%

following abdominal perineal resection varied

of patients especially those with sacral dorsal

from 8% to 70%.48 For anterior resections the

root involvement.45 Retrograde viral transport

incidence of voiding dysfunction is lower at

to the SPN interferes with the micturition reflex

20–25%.48 New techniques by colorectal sur-

causing detrusor areflexia. If thoracolumbar

geons that avoid dissection beneath the pre-

levels are involved, retention may be due to

sacral fascia, avoiding levator muscle division,

increased sympathetic outflow to the bladder

vaginal dissection, and careful dissection near

outlet. Sensation in the afflicted dermatomes is

the prostatic apex often spare these nerves and

reduced and a bulbocavernosus reflex often

the incidence has fallen. Detrusor hypocontrac-

weak or absent. Retention develops days to

tility, impaired sensation, reduced compliance,

weeks after the skin eruption and lasts for

and increased capacity are found on UDS. An

4–8 weeks.

open bladder neck may be present on video

Late stages of syphilis can trigger detrusor

UDS. Postvoid residuals are often found.

areflexia and reduced bladder sensation causing

Although most patients are continent, subse-

urinary retention. Rarely, DO has been

quent surgery on the bladder outlet such as a

reported.

TURP may result in incontinence secondary to

Guillain-Barre is an autoimmune disorder

intrinsic sphincter deficiency. Preoperative UDS

that causes demyelination of smalland large-

are usually not helpful in predicting this out-

diameter axons. Up to 50% of patients manifest

come although reduced compliance and an open

autonomic neuropathy. Detrusor areflexia and

bladder neck are worrisome findings.

reduced bladder sensation leads to large post-

Radical hysterectomy with removal of utero-

void residual urines or retention. Spontaneous

sacral and cardinal ligaments can cause vesi-

resolution takes at least 6–8 weeks.

courethral dysfunction. Reduced compliance