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Dr. Venkatesh Krishnamoorthy

Dr. Venkatesh Krishnamoorthy

M.S., MCh (Urology), FRCS (Glasgow)
Sr. Consultant Urologist and Chairman, NU Hospitals

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.

Conditions Treated:

Neurogenic Bladder Right Arrow

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 sitThis 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.

Neuro-Urology Right Arrow

Patients with a neurogenic bladder present one or more of the following signs and symptoms:

  • Retention of Urine
  • Inability to Control Urination (Frequency and Urgency)
  • Urinary Incontinence
  • Loss of Bladder Sensation
  • Disturbance of Bowel Control: is also very common
  • Coma, Paralysis: The above symptoms are in addition to the general symptoms of neurological injury such as coma/paralysis, etc.

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:

  • Urine Analysis
  • Ultrasound Evaluation
  • Tests that Document the Degree of Change in the Urinary Tract
  • Urodynamic Study: This is similar to the ECG study of the heart function. This is performed by passing various small catheters of different sizes into the urinary passage and the rectum. This test also measures the activities of the sphincters. All of these are studies performed on a computer.
    For further information click the link: Urodynamics.
Neuro-Urology Treatment : Right Arrow

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:

  • Clean Intermittent Self-Catheterisation (CISC) for Men and Women: is the simplest of treatments that teaches patients to pass a catheter themselves, every 4-6 hours, depending upon the urine volumes, to keep the bladder empty and also to prevent incontinence.
    For further information click the link: Clean Intermittent Self Catheterisation Female (CISC)
    Clean Intermittent Self Catheterisation Male (CISC)
  • Medical Treatment: Medicines are also used to reduce the pressures in the bladder. Usually, the tablets will have to be taken for a lifetime, until alternative therapies can be instituted.
  • Bowel Management: Management of neurogenic bladder must also include bowel management as an integral part of the treatment. This may include the change in the dietary fiber, enemas, digital evacuation of stools, etc.
  • Surgery: is performed either to reduce the pressures in a bladder by adding bowel segment resulting in an increase in capacity, or by inserting an artificial sphincter to prevent a constant leak of urine. Surgery is resorted to only if all other measures have failed.

NU Hospitals has been pioneering in Nephrology, Urology and Fertility (IVF) treatment over the last 20 years. Our highly specialised experts are richly experienced in treating rare and complex conditions. It was one of the first in Karnataka to conduct a successful kidney transplantation surgery and also the first to equip Urology department with the most advanced flexible endoscopes. Having a robust team of subspecialty specific urology team at NU has significantly improved the overall success rates. Men’s Health Clinic is one of its kind in South-India dealing with Men’s Sexual and Reproductive Health. Our Male and Female Fertility (IVF) specialists comprehensively support the couples with the latest treatment and heartfelt compassion every step along the path to parenthood. At NU, every aspect of healthcare is coordinated and the entire team works together to provide exactly the care one needs. We are constantly updating the policies and collaborations to ensure that people in need are getting access to the most cutting-edge care and treatment.

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