Neurourology

Located at the meeting point of urology and neurology, neuro-urology is concerned with the assessment and treatment of functional disorders of the urinary bladder and urethral sphincter and the treatment of the involuntary leakage of urine, known as urinary incontinence or aconuresis.

In particular, neuro-urology is devoted to the women, men and children affected by a disease of the nervous system. In addition, many people with other bladder disorders - with or without accompanying urinary incontinence - can benefit from a specific neurourological assessment and treatment.

Neuro-urology is a young field of medicine that has evolved rapidly over the last 30 years. It has already seen a huge increase in understanding and achieved notable treatment success. Today it is possible to successfully treat nine out of ten people suffering from a functional disorder of the bladder.

When and how can neurourology help?

The bladder and pelvic floor are controlled by nerve centres in the brain and spinal cord. They can only function normally if the complex interplay of the bladder, sphincter and nervous system is working properly. But if bladder control is impaired, this can lead to involuntary urine leakage (incontinence) or difficulty in emptying the bladder. With the help of functional tests, ultrasounds, endoscopies and X-rays, an experienced neurourologist can establish the underlying problem and start the right treatment. 

For which medical conditions is a neurourologist's advice needed?

If the bladder and pelvic floor are not working properly because of damage to the brain and spinal cord or a nervous system disease, this is known as a ‘neurogenic bladder’. Common symptoms of a neurogenic bladder are not feeling when the bladder is full, loss of control and/or difficult or incomplete emptying. Increased bladder infections are also not uncommon.

Causes of a neurogenic bladder may include:

•      Traumatic para- or tetraplegia

•      Congenital neurological defects (spina bifida, meningomyelocele)

•      Circulatory disorders, infections or tumours in the spinal cord

•      Neurodegenerative diseases such as multiple sclerosis, Parkinson’s disease and dementia

•      Brain damage through injury, inflammation or a stroke

•      Spinal cord damage through slipped discs or spinal stenosis

Neurourology treatment:

Options include conservative treatment and surgery.

Conservative measures:

•      Medication

•      Pelvic floor and sphincter training with biofeedback

•      Functional stimulation of the pelvic floor

•      Bladder instillation

•      Alternative medicine (e.g. body-mind)

•      Advice and use of aids

Surgical treatment:

•     Injection of the urethra for incontinence

•     Injection of the bladder with botulinum toxin for urge incontinence

•      Sling surgery for men and women with stress incontinence

•      Correction of pelvic organ prolapse (sinking of the bladder, uterus and rectum in women)

•      Endoscopy treatments for the urethra, prostate and bladder for narrowing of the urethra, enlarged prostate or bladder stones/tumours

•      Prosthetic sphincter (ProACT, ATOMS, AMS 800) for incontinence after prostate operations

•      Bladder pacemakers (sacral neuromodulation with the INTERSTIM system) for urge incontinence, pain or difficulty emptying the bladder