Patients with neurogenic bladder due to disorders affecting the central nervous system typically present with signs of urinary frequency, urgency, and bladder overactivity, but there is little recent peer-reviewed original research on the initial imaging of this condition associated with renal failure. Underactivity of the bladder is less common, and it is characterized by prolonged voiding with a sensation of incomplete emptying and hesitancy; however, imaging is not generally part of the evaluation of underactive bladder [45]. Approximately 26% of patients with neurogenic bladder from spina bifida will develop renal failure, but <2% progress to end-stage renal disease [46]. Nearly all patients with spinal cord injury have historically developed renal dysfunction, which has been a major cause of death until more recent advances in diagnosis and care [47]. Patients with spinal cord injury have a 7% risk of stone development within 10 years, and this can contribute to renal insufficiency [47]. Review of clinical history, physical examination, US and urodynamic studies are the key components of an initial diagnosis of neurogenic bladder in Europe [48], but recommendations vary by country. For example, urodynamic evaluation is not recommended in British guidelines [49]. CT Abdomen and Pelvis Unenhanced CT is useful for characterization of US-detected hydronephrosis by determining the level and cause of obstruction. CT can determine if there is hydronephrosis, measure renal size/volume, and assess urinary bladder distension and wall thickening but it is generally not considered a first-line imaging modality [16]. CT may be considered if US is not feasible or is nondiagnostic because of body habitus. There is no relevant literature regarding the use of CT abdomen and pelvis without and with IV contrast in the evaluation of renal failure associated with neurogenic bladder, but CT with IV contrast is not a first-line test for evaluation of kidney failure due to neurogenic bladder.
Renal Failure. Patients with neurogenic bladder due to disorders affecting the central nervous system typically present with signs of urinary frequency, urgency, and bladder overactivity, but there is little recent peer-reviewed original research on the initial imaging of this condition associated with renal failure. Underactivity of the bladder is less common, and it is characterized by prolonged voiding with a sensation of incomplete emptying and hesitancy; however, imaging is not generally part of the evaluation of underactive bladder [45]. Approximately 26% of patients with neurogenic bladder from spina bifida will develop renal failure, but <2% progress to end-stage renal disease [46]. Nearly all patients with spinal cord injury have historically developed renal dysfunction, which has been a major cause of death until more recent advances in diagnosis and care [47]. Patients with spinal cord injury have a 7% risk of stone development within 10 years, and this can contribute to renal insufficiency [47]. Review of clinical history, physical examination, US and urodynamic studies are the key components of an initial diagnosis of neurogenic bladder in Europe [48], but recommendations vary by country. For example, urodynamic evaluation is not recommended in British guidelines [49]. CT Abdomen and Pelvis Unenhanced CT is useful for characterization of US-detected hydronephrosis by determining the level and cause of obstruction. CT can determine if there is hydronephrosis, measure renal size/volume, and assess urinary bladder distension and wall thickening but it is generally not considered a first-line imaging modality [16]. CT may be considered if US is not feasible or is nondiagnostic because of body habitus. There is no relevant literature regarding the use of CT abdomen and pelvis without and with IV contrast in the evaluation of renal failure associated with neurogenic bladder, but CT with IV contrast is not a first-line test for evaluation of kidney failure due to neurogenic bladder.