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On a bleak Sunday morning, as I was on duty working as a doctor in newborn medicine at the Royal London hospital in the UK, I got the ....

Neurogenic Bladder

Neurogenic bladder is an abnormality of bladder function that follows damage to the neurological control of the bladder and control muscles. This may result from a birth defect, trauma such as a road side accident or fall from a height, tumor, or infections like tuberculosis. In some individuals, there may be classical findings consistent with neurogenic bladder without an obvious identifiable neurological problem. Neurogenic bladder can have a significant impact on lifestyle. Untreated neurogenic bladder can lead to kidney failure. In fact, long term serious problems in patients with spinal disease come from the kidneys rather than the spine. It is a sad fact that we continue to find patients walking into our clinic with established kidney failure due to neglected or mis-managed neurogenic bladder with disconcerting regularity.

We have an entire team for managing such patients and have a state-of-the-art urodynamics machine (MMS, Denmark). Dr Sanjay Sinha has spoken in invited symposia of the Urological Society of India in the Neurourology subsection in the past and conducted workshops for the training of urologists and gynecologists in Urodynamics techniques at Hyderabad, PGI Chandigarh, Jhansi, New Delhi, Taipei and Johannesburg.

For some patients with neurogenic bladder whose bladders have unsafe storage pressures despite medication, augmentation cystoplasty is a standard and potentially life saving procedure. Such patients are at high risk of damaging their kidneys. Timely surgery can prevent such damage. Of note, once the kidneys have already got damaged such surgery may no longer be feasible condemning the patient to long-term kidney failure. Urodynamics evaluation can easily help in predicting and avoiding this problem.

Dr Sinha has extensive experience in augmentation cystoplasty for neurogenic bladder both in children and in adults.

Figure 1 Augmentation cystoplasty for neurogenic bladder

In some patients with neurogenic bladder, botulinum toxin injections into the bladder can be very useful. Again, these injections are used only in patients who fail to respond adequately to medication. Such patients are at high risk for damage to the kidneys. Botulinum injections are given directly into the bladder wall under endoscopic guidance under anesthesia. They are very effective. However, the effect of the injection lasts for between 6-12months and then the procedure needs to be repeated. It is also expensive.

Such injections are specifically very useful for those who want to avoid an operation either temporarily (eg an unmarried child) or in the long term. It is crucial for those with poor bladder function in whom the kidneys have already got damaged. In this situation the standard augmentation cystoplasty surgery cannot be done. Botulinum toxin injections can offer an effective last option in such patients.

Dr Sinha has a large experience with the use of botulinum toxin in adults and children both for the bladder as well as for the sphincter.

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