Neurourological disorders

What is a neurourological disorder?

The nervous system connects the brain and spinal cord to all parts of the body through a network of nerves. A disturbance in that network can cause problems storing and passing urine. Urinary problems caused by the nervous system are called neurourological disorders.

What is neurogenic lower urinary tract dysfunction?

The lower urinary tract consists of the bladder and urethra and includes the prostate in men (Figures 1a and 1b). The bladder stores the urine produced by the kidneys. It is a hollow stretchy bag made of muscle tissue that sits on the pelvic floor muscles. Normally the bladder is able to store urine without building up high pressure. Below the bladder, the urinary sphincter helps store the urine and prevent leakage. It is composed of different parts and muscle layers. The urethra is the tube through which urine passes from the bladder out of the body.

The main functions of the lower urinary tract are storing and passing urine. Both functions are regulated by the nervous system, which coordinates interaction of the bladder and the sphincter. For normal storage, the bladder muscle should be relaxed and the sphincter muscles tense. For urination, the bladder muscle should contract to build up pressure and to press the urine out, and the sphincter should relax to allow for easy and complete emptying without resistance.

These functions involve many parts of the nervous system, including the brain, the spinal cord, and the peripheral nerves. Any disturbance of these parts can lead to malfunction of normal storage and voiding and cause many symptoms. This disturbance is called neurogenic lower urinary tract dysfunction.

You may have a neurogenic lower urinary tract dysfunction if you also have one or more of the following conditions:

• A neurologic disease such as dementia, stroke, or multiple sclerosis
• Previous surgery or injury to the spine or pelvis
• Previous radiation
• Deformity of the spine
• A slipped disc
• A brain tumour or abnormal cell growth that affects the nervous system
• Diabetes
• Numbness or pain in the hands or feet (called peripheral neuropathy)

Symptoms and complications of neurogenic lower urinary tract dysfunction

Symptoms and complications of neurogenic lower urinary tract dysfunction depend on where the problem is in the nervous system. Maybe you’ve noticed that normal storage and passing of urine is disrupted. Sometimes a problem doesn’t cause any discomfort.

Symptoms include:

• Slow or incomplete emptying of the bladder
• No sensation of the bladder
• Feeling abdominal fullness
• Not knowing when or if you will urinate (bladder spasticity)
• A frequent and compelling urge to empty the bladder, day or night, that is difficult to defer
• Incontinence
• Pain in the bladder or genital region

The location of the neurological problem usually influences the type of symptoms the patient may experience, for example: storage symptoms, urinary urgency or voiding symptoms, such as a weak urinary stream (Figure 2). Urological problems that occur after sudden changes like spinal injury tend to be more severe than those caused by chronic conditions.

Diagnosis of neurourological disorders

Early diagnosis and treatment are essential in neurourological disorders. Early intervention can prevent irreversible changes of the lower and upper urinary tract.

When diagnosing neurourological symptoms, your doctor may:

• Take a thorough medical history
• Ask you to keep a bladder diary
• Ask you to complete a quality-of-life questionnaire
• Do a physical examination
• Test how your bladder fills and empties with pressure measurements (urodynamics)
• Check your kidney function

Treatment of neurourological disorders

If you have a neuro-urological problem, the main goal is to protect your kidneys and ureters. These organs compose the upper urinary tract.

Kidney failure may result from many neurological conditions, for instance, spinal cord injuries. Your urologist may suggest a treatment to protect your kidney function even if you don’t have bothersome symptoms.

Provided that your kidneys are safe, priorities in neuro-urology treatment are:

• Restoring the normal function of the bladder
• Achieving or maintaining continence to improve quality of life

General information about neurourological disorders

Urinary tract infection in neurourological patients

Urinary tract infection (UTI) is diagnosed with common signs and/or symptoms:

• Strong urge to urinate that doesn’t go away
• Burning sensation or discomfort when urinating (dysuria)
• Passing frequent, small amounts of urine
• Cloudy urine with increased urine odour
• Pink, red, or brownish urine
• Pain above the pubic bone in women

Laboratory findings like a lot of bacteria or white blood cells in the urine confirm the diagnosis.

In neuro-urological patients, UTI can be caused by:

• Weakened defence mechanisms
• Inability to empty the bladder completely
• Catheterisation

Asymptomatic bacteriuria is the presence of bacteria in the urine without symptoms. It is much more common in patients with spinal cord injury than in the general population. The condition varies depending on bladder management—for example, clean intermittent catheterisation or an indwelling catheter. It should not be routinely screened for or treated in patients with neuro-urological disorder.

If you have a symptomatic UTI, you may have other signs and symptoms in addition to or instead of traditional signs and symptoms of a UTI:

• Fever
• Incontinence
• Unpredictable need to urinate
• Malaise
• Lethargy or sense of unease
• Discomfort or pain over the kidney or bladder
• Sudden occurrence of high blood pressure (autonomic dysreflexia)

If a symptomatic UTI is present, your doctor wmay do a urinalysis and take a urine culture to identify the bacteria involved.