Neuro-Urology deals with the diagnosis and treatment of urological conditions that result due to damage, disorders or diseases of a neurological nature or when the normal functioning of the brain is affected.
Neurogenic Bladder: Neurogenic bladder is a dysfunctional lower urinary tract that occurs due to causes other than primary urinary tract pathology.
The act of passing urine is completely voluntary, except in infants and small children who have the automatic and involuntary passing of urine. Urination is initiated when a person wants to pass urine and can be controlled if the process of passing urine should be free, without the need to strain and should empty the bladder fully each time urination takes place. When the bladder keeps filling, the sphincters tighten and prevent the leakage of urine. When the bladder contracts to empty, the sphincters open to let urine out.
These work in an extremely coordinated manner. Any condition other than this – such as an involuntary leakage of urine or any difficulty experienced in urination – is abnormal, and needs evaluation.
The passing of urine, or the control of urination, is regulated by the central nervous system. Messages from the brain are sent through the spinal cord and the lumbar and sacral nerves, to the bladder and the sphincters.
This control is lost if the spinal cord or its nerves are damaged or the normal functioning of the brain itself is affected. The bladder may then lose sensation and fail to empty. Or it may overwork – the sphincter may or may not open appropriately.
Diseases such as Parkinson’s, Alzheimer’s, large cerebral Haemorrhage, Dementia, spinal cord injury/tumors/transverse myelitis, Diabetes Mellitus or injury to the nerves by surgery, etc., may all cause a neurogenic bladder.
Patients with a neurogenic bladder present one or more of the following signs and symptoms:
While the physical disabilities may seem very frightening, they are usually not life-threatening. But bladder dysfunction, while not very overt, is usually the cause of severe morbidity, renal failure and even death. It is often neglected due to a lack of awareness of its ill-effects.
The clinical diagnosis of a neurogenic bladder is made on the basis of certain simple and preliminary tests such as:
The focus in managing a neurogenic bladder is to prevent renal damage. Renal damage occurs due to intolerably increased pressures in the bladder, causing a back-pressure effect on the kidneys, resulting in their slow damage without symptoms in the early stages. The kidneys also develop urinary tract infection, stones, etc.
All treatment is therefore aimed at reducing these bladder pressures. A normal urination may or may not be achieved, but this is not important. If this happens in the process of treatment, it is a bonus. Treatments for neurogenic bladder are: