Why Yale Urology?
At Yale, we are committed to providing you with the highest level of up-to-date, excellent and compassionate care. We understand that a diagnosis of neurogenic bladder can have a significant impact on your quality of life. Yale Urology is staffed by experts who respect you and understand your concerns and needs. We look forward to working with you, and we will develop a treatment plan that works for your individual lifestyle and we will coordinate that plan with the treatments provided by the rest of your healthcare team, including neurologists, physiatrists, and primary care specialists. We value communication and cooperation as vital components of your healing process.
Yale is a premier academic health center, affiliated with one of the best research institutions in the world. Our mission in the Department of Urology at Yale is to perform research and discover next generation methods for treatments of diseases like neurogenic bladder. Our faculty members participate in cutting edge clinical trials, and we are continually looking for new ways to adopt innovative treatments from around the globe as new advances come to light. We are well equipped to deliver currently available treatment options for neurogenic bladder, including sacral neuromodulation, onabotulinumtoxin A bladder injections, and complex bladder reconstructive surgery. (See section on Reconstructive Urology for more information.)
What is Neurogenic Bladder?What is a neurogenic bladder? The muscles and nerves of the urinary system efficiently work together to hold urine in the bladder and then release urine at the appropriate time. Nerves carry messages or signals from the bladder (which is mostly composed of muscle) and urethral sphincter muscle (USM, this is a “valve-like” area in the urethra urine tube just beyond the bladder) to the spinal cord and brain. The brain coordinates the messages coming from the bladder and USM to store urine in the bladder (continence) or to empty urine out of the bladder (micturition or voiding) at times convenient to the person. Continence and micturition involves the bladder muscles and USM to work in tandem; though their functions are always complementary. What this means is that during continence (urine storage), the bladder muscle is relaxed, the USM is contracted. During voiding, the bladder muscle is contracted and the USM is relaxed. A neurogenic bladder is the condition when the bladder and USM functions abnormally due to any nerve or neurologic problem, such as spinal cord injury, spina bifida, cauda equina syndrome, multiple sclerosis, stroke, transverse myelitis, brain tumors, cerebral aneurysms, Parkinsons, Alzheimers, multiple system atrophy (MSA), and other degenerative nerve disorders.
In a neurogenic bladder, because of the neurologic condition, nerves carrying these messages do not communicate properly with the bladder muscle and the USM leading to problems with continence or voiding. One problem neurogenic bladder patients experience is urine leakage (loss or urine control). Urine leakage often occurs when the bladder muscle does not get the right message and contracts without the patient’s permission. Another problem is inability of the bladder to completely empty (called urinary retention). Urine retention often happens if the bladder muscles do not get a signal from the nerve to contract, or if the USM does not get the message to relax during voiding. The ability for the neurogenic bladder patient to sense bladder fullness or to feel urine flow during voiding varies depending on the type of neurologic condition he/she has. While counter-intuitive, some neurogenic bladder patients have frequent sensations to urinate even with low bladder volumes. This may be secondary to loss of inhibitory signals (inability to block unwanted signals) which are also necessary for normal bladder function. The symptoms of neurogenic bladder may resemble other conditions and medical problems. Always consult your physician for a diagnosis.