What is Urology?

Urology: Urinary & Reproductive Disease Diagnosis & Treatment

Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.

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A Lifelong Journey: Surveillance Protocols

Neurogenic Bladder

Neurogenic bladder is rarely “cured” in the usual sense; it is managed over time. Recovery means keeping kidney function, staying continent in social situations, and avoiding infections. Following up regularly is the most important factor for long-term health. Patients need to know that “feeling fine” does not always mean the bladder is safe, since high pressure can cause silent damage.

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The Surveillance Schedule (Typical Protocol for SCI/Spina Bifida)

Neurogenic Bladder
  • Annual Check-up: Renal Ultrasound (to check for hydronephrosis/stones) and Serum Creatinine/eGFR (kidney function).
  • Every 1-2 Years: Videourodynamic testing (to check whether bladder pressures remain safe). If pressures rise (>40cm H2O) or compliance drops, treatment must be escalated (e.g., Botox or Surgery).
  • Annual Cystoscopy: For patients with suprapubic or indwelling urethral catheters for >10 years, to screen for bladder cancer.
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Urinary Tract Infections (UTIs)

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  • Asymptomatic Bacteriuria: Bacteria living in the urine without symptoms (fever, pain, bloody urine, increased spasticity) should NOT be treated with antibiotics in neurogenic patients. The bladder is colonized. Over-treatment leads to “Superbugs” (Multi-Drug-Resistant organisms).
  • Symptomatic UTI: Fever, increased spasticity (legs jumping), malaise, foul-smelling urine, or autonomic dysreflexia requires culture-specific antibiotic treatment.

Bladder Stones. Because the bladder may not empty or contain mucus (from augmentation), stones can form on catheter tips or mucus plugs can form. These act as a nidus for infection. They are treated endoscopically (cystolitholapaxy). Prevention involves high fluid intake and regular irrigation.

Latex Allergy Patients with Spina Bifida and SCI have a very high rate of latex allergy due to chronic exposure to medical products early in life. Liv Hospital maintains a strictly Latex-Free environment for these patients to prevent anaphylaxis.

Lifestyle and Coping

  • Fluid Management: Patients on CIC typically aim for urinary volumes of 400-500ml per catheterization. This usually means restricting fluid intake to about 1.5-2 liters per day, timed appropriately.
  • Bowel Management: The “Neurogenic Bowel” almost always accompanies the neurogenic bladder. Constipation worsens bladder function (fecal impaction compresses the urethra and triggers spasms). A strict bowel regimen (fiber, softeners, scheduled evacuation/suppositories/enemas) is critical for bladder success. The MACE (Malone Antegrade Continence Enema) procedure can help manage bowels surgically.
  • Skin Care: Protection from urine is vital. Incontinence-associated dermatitis (IAD) breaks down the skin barrier, leading to pressure ulcers. Barrier creams and high-quality wicking pads are essential.
  • Travel and Independence: We provide patients with “Travel Certificates” for carrying catheters on airplanes and assist in planning supply logistics.

Transition of Care: Pediatric to Adult

A critical phase in neurogenic bladder care (specifically for Spina Bifida) is the transition from pediatric to adult urology. This usually occurs between ages 16 and 18. This period is high-risk for “loss to follow-up” and subsequent renal failure. Liv Hospital employs a structured Transition Program to ensure young adults take ownership of their bladder management, catheterization supplies, and appointment scheduling before leaving the pediatric service.

Neurogenic Bladder

Psychological Support

The psychological burden of incontinence, dependence on catheters, and altered body image is heavy. Depression rates are higher in this population. Liv Hospital integrates psychological support, helping patients adjust to their “new normal,” fostering independence, and addressing body image concerns regarding sexuality and catheterization. Caregiver burden also involves providing resources and respite strategies for family members who are assisting with care.

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FREQUENTLY ASKED QUESTIONS

What are the signs of a UTI in a person with no sensation?

Since you may not feel “burning on urination,” look for other signs: fever, chills, cloudy or foul-smelling urine, frank blood in urine, sudden increase in muscle spasms (spasticity) in the legs, or the onset of Autonomic Dysreflexia episodes. “Feeling generally unwell” or confused is often the only sign in elderly or high-level injury patients.

The key is to empty the bladder (no residual urine) frequently. If you have an augmented bladder (bowel patch), you must irrigate (flush) the bladder with saline daily to wash out mucus, as mucus clumps can serve as seeds for stones to grow on. Drinking plenty of water also helps dilute the minerals.

Yes. Women with neurogenic bladder can conceive and carry a pregnancy. However, pregnancy increases the risk of UTIs and hydronephrosis. Catheterization may become difficult as the belly grows. Kidney function must be monitored closely. A C-section might be planned to avoid pelvic floor trauma. Men may require sperm retrieval techniques (vibrostimulation or electroejaculation) if they have retrograde ejaculation or anejaculation.

Because kidney damage from neurogenic bladder is “silent.” You will not feel pain if your kidneys swell (hydronephrosis) due to high bladder pressure. By the time you feel sick (nausea, lethargy), the kidneys may have failed irreversibly. The annual ultrasound is your early warning system to catch damage while it is still reversible.

Cranberry extracts (specifically D-Mannose) may help prevent E. coli bacteria from sticking to the bladder wall, potentially reducing UTI frequency. They are generally safe but should not replace proper catheterization technique or medical treatment for active infections. Discuss with your doctor, as high doses can interact with blood thinners (Warfarin) or increase the risk of specific kidney stones (oxalate).

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