Neurourology/Neurogenic Bladder

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. 

Innovative Treatments

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?

A neurogenic bladder is the condition when the bladder and urethral sphincter muscle (USM) function abnormally due to a nerve or neurologic problem such as spinal cord injury, spina bifida, cauda equina syndrome, multiple sclerosis, stroke, transverse myelitis, brain tumors, cerebral aneurysms,  Parkinson's Disease, Alzheimer's Disease, multiple system atrophy (MSA), and other degenerative nerve disorders.

Because of the neurologic condition where nerves are not communicating properly with the bladder muscle or the USM, this can lead to problems with continence or voiding.  Urine leakage (loss of urine control) is a common issue faced by patients, and often occurs when the bladder muscle does not receive the right message and contracts without the patient’s permission.  Inability of the bladder to completely empty is another common symptom of neurogenic bladder.  Urine retention often happens if the bladder muscles do not receive a signal from the nerve to contract, or if the USM does not receive the signal to relax during voiding.  The ability for the 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. The symptoms of neurogenic bladder can resemble other conditions and medical problems, so it is always recommended to consult your physician for a diagnosis.

Complications of Neurogenic Bladder

A bladder infection or urinary tract infection (UTI) is a frequent complication faced by patients with neurogenic bladder.  While bladder infections can occur in anyone, neurogenic bladder patients have a higher risk of UTIs because of the inability of the bladder to empty normally, a lack of sensation of bladder fullness resulting in holding urine too long before being eliminated, a lack of the bladder muscle and USM working in tandem during voiding leading to higher bladder pressures, and for some, it is a result of performing bladder self-catheterization. 

Kidney damage is another common complication of bladder infections.  Damage to the kidney can happen if abnormal high pressures in the bladder are transmitted to the kidneys, causing kidney injury or allowing infection from the bladder to go into the kidney.  Urinary tract stones (in kidneys and/or bladder) are also more common in patients with neurogenic bladder, especially those who have had recurrent bladder infections.  Patients using self-catheterization have risks beyond urinary tract infection including urethral strictures and/or urethral bleeding.  Patients with chronic (permanent) indwelling catheters have risks of severe urinary tract infections, bladder stones, bladder cancer, and urethral injuries. 

How is Neurogenic Bladder Evaluated?

Patients with known, established neurologic diseases, and who also have bladder symptoms, are referred to a urologist for further evaluation to manage their bladder symptoms. Testing includes checking urine for infection, looking into the bladder with lighted flexible tube (cystoscopy), performing a bladder pressure test with a catheter into the bladder (urodynamics), as well as completing a dye test to see if urine is backing up into the kidney.  Urologists may also order kidney imaging tests such as an ultrasound or CT scan to make sure the kidneys are not damaged.  These tests help to guide the urologist to determining the optimum treatment for neurogenic bladder.   

What is the Treatment for Neurogenic Bladder?

Specific treatment for neurogenic bladder will be determined by your urologist based on several factors, including: Your age, overall health, and medical history; Severity of symptoms; Cause of the nerve damage or neurologic condition; Type of bladder symptoms (incontinence vs. retention); Your tolerance for specific medications, procedures, or therapies; Expectations for the course of the condition; and your opinion or preference.