Neuro Urology is the study of the mechanisms of Nervous control for complete and efficient passage of urine. Bladder is a hollow organ located in lower abdomen that helps to store and empty urine at periodic and convenient timing. Neurological conditions like stroke, spinal cord tumors spinal cord injury, disc prolapse, etc. can affect bladder function resulting in neurogenic bladder.
Neurogenic lower urinary tract dysfunction or Neurogenic bladder as it is commonly called can affect people of all ages. It can occur because of a congenital condition, an acutely acquired event or a chronic degenerative condition. The basic principles of neuro urology are simple, 1. Protecting renal function, ensuring a safe bladder that stores and empties well without stones and infection and preserving their quality of life.
Function of the lower urinary tract is governed by an intricate neurologic system that coordinates storage and voiding of urine. 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 nerves, to the bladder and the sphincters. Disturbances to the central nervous system , the autonomic nervous system or peripheral nervous system may result in NGB. 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 situation is not conducive.
This process of passing of 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.
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.
Our team has extensive expertise in caring for individuals who have a neurogenic bladder as a result of congenital malformations (present at birth) or medical conditions, including:
Basically when the central system or brain is affected there is loss of inhibition, uninhibited bladder contractions and so there is increased frequency and urgencywith or without incontinence. When the micturition center is affected the co- ordination is lost, i.e sphincter doesn’t relax at the time of bladder contraction. When the peripheral nerves are affected there is loss of bladder sensation and inability to contract bladder leading to retention.
The above symptoms are in addition to the general symptoms of neurological injury such as coma/paralysis, etc.
Our diagnoses are made on the basis of various urodynamic procedures, through which the processes can be made both measurable and visible, as well as video-urodynamic investigations. We also carry out complex incontinence assessments, urine analyses, urological radiology(CT, MRI, USG, VCUG), cystoscopy/endourology, diagnostic sonography of the urinary tract and sexual organs and neuro-urological neurophysiological examinations.
Our multidisciplinary team includes specialists in, sexual medicine, infertility, men's health, urogenital reconstruction, urinary stone disease, and general and pediatric urology who are dedicated to treating and preventing disease, as well as improving quality of life. We collaborate with experts in physical medicine and rehabilitation, neurosurgery, internal medicine, and psychology and social work
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.
Depending on underlying neurological damage, bladder may be OVERACTIVE ( Neurogenic bladder ) with retention of urine, or under active described as urinary incontinence .
Apart from detailed history and physical examination your doctor may order tests called Urodynamic studies to diagnose Neurogenic Bladder. Urodynamic studies (Bladder Function Tests) are conducted to measure bladder capacity, bladder pressure, urine flow and bladder emptying. A cystoscopy may be performed to examine the inside of bladder and urethra with a small telescope to identify the effects of impaired bladder functions and the effects of long standing stasis of urine like stone formations, infections etc.
There are many types of treatment for Neurogenic Bladder. The appropriate treatment for an individual is determined by symptoms, type & extent of nerve damage and discussion with the patient about their requirements .
Physical and Psychological Therapy: It is also called fixed voiding, combines will power and exercise. It helps you to gradually improve your control over urination.
Drug Therapy: There are certain drugs that reduce bladder contractions, e.g. Tolterodine Tartrate, Bethanacol Sodium which improve the bladder contractions.
Clean Intermittent Self Catheterization: Patients can insert Catheters through urethra into bladder to drain urine. This treatment is called Clean Intermittent Catheterization (CIC).
Artificial Sphincters: Consists of creation of an artificial cuff that fits around bladder neck to control urination.
Urinary Diversion: Creates a stoma (opening) through which urine is sent to a collection pouch.
Bladder Augmentation:Segments of intestine are removed and attached to wall of bladder to reduce bladder pressure and improve bladder capacity.
Sphincterotomy: Urinary sphincter can be surgically weakened to improve bladder emptying.
Electrical Stimulatory Therapy: Here electrodes are placed near nerves supplying the bladder. Bladder storage and emptying is improved by stimulating these electrodes.
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.
Lifestyle Treatment: Dietary changes, Bladder training, pelvic floor exercises with biofeedback have an important non invasive role to play in treatment.
Medical Treatment: Medicines are also used to reduce the pressures in the bladder.Usually, the tablets will have to be taken fora lifetime, until alternative therapies can be instituted. We perform medication-based treatments and, bladder instillation therapy, collagen injections for the urethra,botulinum toxin injections in the bladder for incontinence.
Surgery: is performed either to reduce the pressures in a bladder by adding other body tissues 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.
Neuromodulation: A new form of treatment, which involves the placement of a pacemaker at the level of the spinal cord, is now being tried out. Selected patients do extremely well with this form of treatment.