The patterns of LUTS are related to the level of the neurological disorder, which may lead to dysfunction of the bladder and/or urinary sphincter, resulting in storage symptoms (urgency, frequency, urge urinary incontinence) or voiding symptoms (poor urinary flow, straining, hesitancy or terminal dribbling). The levels are classified into:
Neuro-urology focuses on diseases and functional disorders of the urinary tract system and genitalia that are related to neurological disorders and spinal cord injuries. The control of the lower urinary tract requires an intact complex nervous network, which can be impaired by neurological disorders. As a result, patients might experience distressful symptoms such as urgency to urinate, incontinence, and frequent urination. For example, neuro-urology targets patients with neurological conditions such as Parkinson’s disease or multiple sclerosis or spinal cord injury who may encounter urological problems like an overactive bladder or underactive bladder.
A neurogenic bladder is generally damage caused by illness or injury that controls the bladder. These may include:
Symptoms of a neurogenic bladder may differ from person to person. However, common notable symptoms are:
If left untreated, neurogenic bladder symptoms may lead to bladder stones, kidney damage, worsening bladder function and recurrent UTIs.
Diagnosis for a neurogenic bladder often involves checking brain, spinal cord and bladder function. Your urologist will obtain a detailed medical history and order various tests such as:
Ultrasound of the kidneys, bladder and prostate and/or CT urogram — these imaging studies aim to evaluate the upper and lower urinary tracts to look for other differential diagnoses and to assess any possible complications.
The primary aims of treatment are to :
Due to the varied nature of neurogenic bladder, treatment options are highly individualised and may include the following.
Patients with neurogenic bladder may require a long-term indwelling urethral catheter to empty their bladders. Long term indwelling urethral catheters can lead to issues such as recurrent urinary tract infections and injury to the urethra or penis. Cystostomy is a surgical procedure where a tube, also known as suprapubic catheter, is inserted into the bladder via the lower abdomen to drain urine. Suprapubic cystostomy is considered to be a less invasive form of urinary diversion.
The placement of the suprapubic catheter can be performed through an open or percutaneous approach.
The catheter usually stays inserted for 4 to 8 weeks before it needs to be changed or removed.
The function of the bladder is to store and empty urine. This requires coordination between the detrusor muscle, urinary sphincter, and central nervous system. However, in patients with spinal cord injuries and other neurological disorders, the bladder muscles and urinary sphincter can lose coordination, resulting in bladder outlet obstruction.
External sphincterotomy helps to overcome that by impairing the external sphincter function in order to reduce the bladder outlet resistance and the bladder pressures during urination. The external sphincter is resected using electrocautery or a cold knife.
There may be resultant urinary incontinence after external sphincterotomy, and may be managed by external devices.
Implantation of AUS is performed for patients with neurogenic stress urinary incontinence. It consists of a fluid-filled cuff that squeezes the urethra, a balloon reservoir implanted in the abdomen and a pump implanted at the scrotum.
During urination, the pump is activated by the patient, and the fluid-filled cuff is deflated as the fluid is transferred into the balloon reservoir, allowing the patient to pass urine. Once urination is completed, the fluid flows from the reservoir into the cuff once again, preventing urinary incontinence. The success rate of AUS is high, but some patients may require reintervention due to mechanical failure.
The main aims of bladder augmentation are to increase bladder capacity and reduce bladder muscle overactivity and pressure to protect the upper urinary tract. In this procedure, the bladder capacity is expanded by incorporating a segment of the intestines into the bladder. It is generally performed only after more conservative options have failed. Intermittent catheterisation may be necessary after this surgery.
Urinary diversion is a surgical procedure to provide an alternative pathway for urine to pass out of the body due to neurogenic bladder dysfunction. Urinary diversion can be divided into continent diversion and incontinent diversion. An ileal conduit is the most common form of incontinent urinary diversion. During the ileal conduit diversion procedure, a small part of the small intestine, the terminal ileum, will be used to divert urine from the ureters to an external collecting bag. One end of the terminal ileum is attached to the ureters, while the other end is attached to a stoma (a small opening in the abdomen). A urostomy bag is placed over the stoma to hold the urine. The bag comes with a valve for drainage of the urine.
A neurogenic bladder may be the result of damage to the neurological system. This leads to an inability to control our bladder and can, understandably, greatly affect our quality of life. Thankfully, there are a variety of interventions that help manage these symptoms. Treatment is also aimed at preventing eventual kidney damage.
If you experience any of the aforementioned symptoms, please visit your urologist for a proper diagnosis and personalised treatment plan tailored to your needs and concerns.
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