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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The symptoms of Neurogenic Bladder are not uniform; the level and extent of the neurological lesion directly dictate them. Patients generally fall into one of two functional categories: Failure to Store (Spastic) or Failure to Empty (Flaccid), although mixed pictures are common, particularly in conditions like Multiple Sclerosis, where lesions are disseminated.
This type is common in Suprapontine (Brain) and Suprasacral (Spinal Cord) lesions. The bladder muscle acts like a spastic muscle in a paralyzed leg; it contracts on its own without warning.
Nocturia: Waking multiple times at night to void, disrupting sleep patterns, and increasing fatigue in patients who often already suffer from neurological fatigue.
To understand urology, one must understand the anatomy it governs:
In patients with spinal cord injuries at or above the T6 level, a full or distended bladder is the most common trigger for Autonomic Dysreflexia. This is a potentially lethal hypertensive crisis.
Bladder and sexual function share the same nerve roots (S2-S4). Therefore, sexual dysfunction is an almost universal accompanying symptom.
Neurogenic bladder happens as a result of nerve damage. Knowing the underlying cause is important for predicting outcomes and planning treatment.
Congenital Causes (Present at Birth)
Acquired Neurological Diseases
Traumatic and Iatrogenic Causes
Systemic and Metabolic Diseases
Infections: Neurosyphilis (Tabes Dorsalis), Lyme Disease, and HIV/AIDS can all cause specific neurogenic bladder neuropathies, such as HIV-associated myelopathy.
Following a sudden spinal cord injury, the body enters a phase called “Spinal Shock.” During this period, which can last from weeks to months, all reflex activity below the injury ceases. The bladder becomes completely flaccid and acontractile, regardless of the injury level. It is crucial to manage the bladder with catheterization during this phase. Only after spinal shock resolves does the bladder reveal its true “neurogenic” nature (e.g., becoming spastic).
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If you have a known history of neurological disease (MS, Parkinson’s, Diabetes, or spinal surgery) and develop bladder symptoms, it is highly likely to be neurogenic. Other clues include a lack of sensation (not feeling the urge to pee), inability to start the stream without pushing, or “reflex” leakage, where you pee without warning. If you have “other” neurological signs, such as numbness in the legs, weakness, or visual disturbances, you should suspect a neurogenic cause and see a specialist.
It feels like a sudden, exploding, pounding headache accompanied by intense heat and sweating on your face, neck, and shoulders, while your legs might feel cold and clammy. You might feel your heart pounding slowly or irregularly. You may feel “impending doom.” If you have a Spinal Cord Injury (T6 or higher) and feel this, you must check your bladder (catheterize) immediately and sit upright to lower blood pressure.
Chronic alcoholism can lead to “Alcoholic Polyneuropathy,” which damages the peripheral nerves similar to diabetes. This can result in a flaccid, underactive bladder with retention and overflow incontinence. Acute alcohol intoxication also suppresses the antidiuretic hormone and dulls senses, leading to bedwetting, but this is a temporary toxic effect, not permanent neurogenic damage.
Neurogenic bladder patients are prone to Urinary Tract Infections (UTIs) for three main reasons: (1) Retention: Urine that stays in the bladder too long (stasis) allows bacteria to multiply. (2) High Pressure: Dyssynergia forces bacteria into the bladder wall (ischemia). (3) Catheterization: Introducing a foreign object (catheter) can push skin bacteria into the bladder. The bladder’s natural defense mechanism (complete emptying) is broken.
No, menopause causes hormonal changes (estrogen atrophy) that lead to “Genitourinary Syndrome of Menopause,” which mimics neurogenic symptoms (urgency/frequency). However, this is due to tissue thinning and receptor changes, not nerve damage. It is an important differential diagnosis to rule out in older women, but it is not classified as a neurogenic bladder.
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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