Diagnosing a neurogenic bladder involves a comprehensive approach to understand the underlying cause and the extent of bladder dysfunction. Here’s a more detailed examination of the diagnostic process:
Medical History: The first step in diagnosing a neurogenic bladder is a thorough review of the patient’s medical history. The doctor will ask about the onset and duration of symptoms, any known neurological conditions, previous surgeries, medications, and other relevant health issues.
Physical Examination: A physical examination, especially of the abdominal area, can provide clues about bladder function. The doctor may also perform a neurological examination to assess nerve function related to bladder control.
Urodynamic Testing:
- Cystometry: This test measures how much urine the bladder can hold, how much pressure builds up inside the bladder as it stores urine, and how full the bladder is when the urge to urinate occurs.
- Electromyography: Electrodes are placed on the skin near the urethra and rectum to measure the electrical activity of the muscles and nerves in and around the bladder.
- Pressure Flow Study: This measures the bladder pressure required to urinate and the flow rate of the urine.
- Cystoscopy: A cystoscope, a thin tube with a camera and light, is inserted into the urethra to examine the bladder’s lining. This procedure can identify abnormalities in the bladder and urethra.
Imaging Tests:
- Ultrasound: This test uses sound waves to create images of the bladder and surrounding structures, helping to identify any abnormalities.
- CT Scan: A CT scan provides detailed cross-sectional images of the bladder and can detect issues like stones, tumours, or other abnormalities.
- MRI: An MRI can provide detailed images of the bladder and surrounding tissues, especially useful if there’s a suspected neurological cause.
- Postvoid Residual Measurement: This test measures the amount of urine left in the bladder after urination. A significant amount of residual urine can indicate poor bladder function.
Urine Tests: A sample of urine may be taken to check for signs of infection, blood, or other abnormalities.
Voiding Diary: The patient may be asked to keep a diary of their urination habits, noting the times they urinate, the amount of urine, and any associated symptoms. This can provide valuable insights into bladder function over several days.
The combination of these tests and assessments allows for a comprehensive understanding of the nature and cause of neurogenic bladder in the patient. Based on the findings, the doctor can recommend appropriate treatment options.