Neurourology is a specialized branch of urology that involves the diagnosis and management of urinary conditions caused due to neuropathic disorders. Neurologists have significant experience in diagnosis and treatment of neurogenic bladder characterized by failure to control bladder function due to underlying neurological conditions, such as multiple sclerosis, spinal cord injuries, spina bifida, cerebral palsy, stroke, and Parkinson’s disease.

Diseases and conditions

  • Overactive Bladder: Overactive bladder is a chronic condition characterized by a frequent, uncontrolled, and sudden urge to urinate. The patients may also experience urinary incontinence, which involves the involuntary loss of urine. The doctor may perform urodynamic testing, urine analysis, cystoscopy, ultrasound, and CT scan to diagnose an overactive bladder.
  • Underactive Bladder: Patients with underactive bladder may experience prolonged bladder emptying or cannot completely void the bladder within a normal duration. The other symptoms of an underactive bladder include recurrent urinary tract infections and straining during urination. Causes of the underactive urinary bladder may be neurogenic, age-related, myogenic, or side effects of certain medications.
  • Urinary Incontinence: Patients with urinary incontinence have a loss of bladder control of varying severity. The severity ranges from occasional unintentional loss of urine during coughing, sneezing, or laughing to having a sudden and uncontrolled urge to urinate that does not allow the patient to reach the toilet in time. Causes of temporary urinary incontinence may be the intake of chocolates, artificial sweeteners, high doses of vitamin C, caffeine, alcohol, and certain medications. Persistent causes of urinary incontinence include childbirth, menopause, enlarged prostate, pregnancy, aging, urinary obstruction, neurological conditions, and prostate cancer.

Procedures and treatments

  • Medical Management: Medical management of an overactive bladder includes pelvic floor physical therapy, medications, nerve stimulation, and Botox injection. Patients with underactive bladder may be treated with medications, double voiding technique, triggered reflex voiding technique, indwelling catheterization, clean intermittent self-catheterization, and suprapubic catheterization. There are various non-invasive therapies for the management of urinary incontinence. It includes behavioral techniques, pelvic muscle floor exercises, medications, electrical stimulation, and medical devices (urethral inserts and pessary). Interventional therapies for urinary incontinence include Botox injections, bulking agent injections, and nerve stimulators.
  • Surgical Management: Surgery is recommended in patients with overactive bladder if non-invasive therapies do not relieve the symptoms. Surgical interventions for urinary incontinence include bladder neck suspension, sling surgery, artificial urinary sphincter implantation, and prolapse surgery.