Neuro-urology & Urodynamics
Neuro-Urology is the medical field concerning the diagnosis and treatment of urological conditions that arise due to damage, disorders, or diseases of neural or neurogenic origin, or if normal brain development is impaired.
A neurogenic bladder is a dysfunction of the lower urinary tract that occurs as a result of factors other than primary urinary tract pathology. Normally, the act of passing urine is voluntary and can be controlled by a person without any difficulty. When the bladder fills, the sphincters tighten and prevent the leakage of urine.
When the bladder contracts to empty, the sphincters open to let urine out. This coordinated process is regulated by the central nervous system, which sends messages through the spinal cord and nerves to the bladder and sphincters.
However, if the spinal cord or nerves are damaged, or the brain’s normal functioning is affected, this control can be lost. As a result, the bladder may lose sensation and fail to empty, or it may overwork, and the sphincter may not open appropriately.
Diseases such as Parkinson’s, Alzheimer’s, large cerebral haemorrhage, dementia, spinal cord injury/tumors/transverse myelitis, diabetes mellitus, or nerve injury from surgery, among others, may lead to the development of a neurogenic bladder.
Patients with a neurogenic bladder typically display various signs and symptoms, including the inability to control urination (frequency and urgency), retention of urine, urinary incontinence, loss of bladder sensation, and disturbance of bowel control. These symptoms may occur in addition to general neurological injury symptoms such as coma or paralysis.
Although physical disabilities caused by a neurogenic bladder are not usually life-threatening, bladder dysfunction can lead to severe morbidity, renal failure, and even death. Unfortunately, this condition is often overlooked due to a lack of awareness regarding its negative effects.
To diagnose a neurogenic bladder, doctors typically perform preliminary tests such as urine analysis and ultrasound evaluation. More advanced tests, such as urodynamic studies, which are similar to ECG studies for heart function, may also be conducted. This involves passing small catheters of different sizes into the urinary passage and rectum to measure sphincter activities and other functions, all of which are recorded on a computer. For additional information, please refer to the link on urodynamics.
The primary aim of managing a neurogenic bladder is to prevent renal damage caused by increased bladder pressures, which can lead to slow damage of the kidneys without early symptoms. In addition, the kidneys can develop urinary tract infections, stones, and other problems. Treatment options are aimed at reducing bladder pressures and may or may not result in normal urination.
Clean Intermittent Self-Catheterization (CISC) is a simple treatment that teaches patients to pass a catheter themselves every 4-6 hours to keep the bladder empty and prevent incontinence. Medical treatment using medication is also an option to reduce bladder pressures. Bowel management is an integral part of neurogenic bladder treatment and may include dietary fiber changes, enemas, and digital evacuation of stools.
Surgery may be necessary as a last resort if all other measures fail. This may involve adding a bowel segment to increase bladder capacity or inserting an artificial sphincter to prevent urine leakage. The goal of all treatments is to prevent renal damage, which can lead to severe morbidity, renal failure, and even death.