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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Diagnosing Neurogenic Bladder is complex because a patient’s symptoms often do not match what is happening in the body. Someone may leak urine but actually have severe retention. Another person may feel no pain, but their kidneys are being damaged by high pressure. This is why Urodynamics is the key test. At Liv Hospital, we use a thorough “Neuro-Urological” evaluation protocol.
Clinical Assessment
The Neuro-Urological History: We pay close attention to neurological history, including bowel function (constipation often occurs due to shared nerves, called “neurogenic bowel”), sexual function (erectile dysfunction can mean nerve damage), and symptoms like numbness, weakness, vision changes (which may suggest MS), or back pain. We also check hand dexterity and thinking skills, since these affect the ability to manage bladder care, such as self-catheterization.
A 3-day log recording fluid intake, voided volumes, and leakage episodes. In neurogenic patients who catheterize, we record the volumes of catheterization. This helps calculate Functional Bladder Capacity, Polyuria, and leakage patterns. It is essential for determining the frequency of catheterization needed.
To measure incontinence, we may do a 1-hour or 24-hour pad test. The patient wears absorbent pads that are weighed before and after use. This gives an exact measurement of urine loss per day, which helps us assess how severe the condition is and track treatment progress.
Urinalysis and culture are mandatory to rule out infection. In neurogenic patients, Asymptomatic Bacteriuria (bacteria without symptoms) is common and often does not require treatment, whereas symptomatic UTI (fever, malaise, increased spasticity, foul smell) requires aggressive therapy. Renal Function Tests: Serum Creatinine and Blood Urea Nitrogen (BUN) are crucial. In high-pressure neurogenic bladders (DSD), renal failure is a “silent killer.” An elevated creatinine in a neurogenic patient warrants immediate upper tract imaging to rule out obstruction.
Ultrasound (USG) and Post-Void Residual (PVR)
Videourodynamics (VUDS). This is the Gold Standard diagnostic test for Neurogenic Bladder. It combines standard urodynamics with real-time fluoroscopy (X-ray). It answers the questions: Is the bladder safe? Does it leak? Does it empty?
Cystoscopy: A visual inspection of the bladder interior using a flexible scope.
Nuclear Medicine (DMSA/MAG3 Scan) is used to assess differential kidney function (split function) and scarring if hydronephrosis is found on ultrasound. It tells us how well each kidney is actually filtering blood and draining.
Ambulatory Urodynamics. When standard urodynamics fail to reproduce the symptoms (because the patient is lying still), ambulatory urodynamics can be used. This involves a portable device that records bladder pressures while the patient moves, walks, and performs daily activities, providing a more “real-world” assessment of bladder function.
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It is generally not painful, but it can be uncomfortable and invasive. It involves placing a small catheter in the bladder and another small pressure-sensing balloon in the rectum. At Liv Hospital, we use local anesthetic gel and take great care to preserve dignity. While inconvenient, it is the only test that can determine if your bladder pressure is dangerous to your kidneys.
Because the bladder and kidneys are a connected plumbing system. If the bladder pressure is too high (due to DSD or low compliance), the urine backs up (reflux). This “back-pressure” silently destroys the kidney tissue (hydronephrosis) without causing pain. Ultrasound serves as an early warning system to protect your kidneys.
This is a specific urodynamic maneuver. We instill ice-cold saline into the bladder. In patients with Upper Motor Neuron lesions (like MS or SCI), this cold shock triggers an immediate, reflexive bladder contraction (the Bors-Bloka reflex) due to C-fiber activation. It helps differentiate between upper and lower nerve damage when the diagnosis is unclear.
If you have a high-risk neurogenic bladder (e.g., Spina Bifida, Spinal Cord Injury), you typically need a Renal Ultrasound. Creatinine check every year, and Urodynamics every 1-2 years, or whenever symptoms change. Lifelong surveillance is the key to survival and preventing renal failure.
Yes. This is called “Silent Retention.” In conditions like Diabetes or Vitamin B12 deficiency, you may lose the sensation of fullness. Your bladder could be holding 1 liter of urine, causing back-pressure on your kidneys, but you feel absolutely nothing. This is why screening people with diabetes with ultrasound PVR is so significant.
Many people struggle with using catheters. Finding other ways to empty the bladder is key. This is true for those with medical conditions that make
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