Neuro-Urology

Overview

Every year, our physicians care for hundreds of patients with lower urinary tract dysfunctions caused by neurological disorders, including multiple sclerosis, Parkinson's disease, spina bifida and stroke. We also treat people who have suffered nerve damage due to brain injuries, spinal injuries and metabolic disorders (e.g. diabetes and obesity).

In every case, our goal is to restore patients to fulfilling, productive lives by helping them manage lower urinary tract symptoms such as:

• Urgency and urge incontinence: the need to urinate with little or no warning (also known as overactive bladder)
• Stress incontinence: uncontrolled urination resulting from coughing, laughing or sneezing
• Voiding dysfunctions (e.g. painful urination, incomplete bladder emptying, slow urinary stream)

What to Expect

Patient care begins with a comprehensive evaluation by one of our neuro-urology specialists. For the initial appointment, please bring your medical records and any test results (if applicable), including X-rays.

During the evaluation, you can expect the following:

• A review of your medical history, test results and notes from your referring physician and/or neurologist
• An in-depth conversation about your urinary symptoms and associated symptoms related to bowel and sexual function
• A discussion of your lifestyle, neurological disorder and any other illnesses, as well as expectations for your treatment and outcome

For your convenience, additional testing (if necessary) is performed onsite. Tests may include:

• X-rays
• CT scans
• Blood tests
• Urine cultures

Our staff also may recommend urodynamics testing, an advanced method to understand the source of the problem. Most tests are noninvasive or minimally invasive and performed on an outpatient basis.

Personalized Care for Your Symptoms

After evaluating you and examining your test results, your physician designs a personalized treatment plan to alleviate your lower urinary tract symptoms. Whenever possible, your physician will begin treatment with a conservative therapy that will be safe, effective and least disruptive to your life.

For example, the physician may start by prescribing oral medication or biofeedback therapy. By beginning with more moderate approaches, we may enable you to avoid invasive procedures, some of which are irreversible and can involve longer recovery times.

If you have a disorder that does not respond to conservative therapy, you may need a surgical procedure to regain control of bladder function. Your treatment, from evaluation through postoperative care, is guided by a neuro-urology specialist who is also a highly skilled and experienced surgeon. In fact, our staff is renowned for its expertise in complex genitourinary reconstructive surgery.

As needed, our physicians work closely with other accomplished specialists at Mass General, including neurologists and rehabilitation professionals. This multidisciplinary approach ensures you receive comprehensive, world-class care for your specific combination of symptoms and illnesses.

Why Specialization Matters

Ranked among the country's leading practitioners in the field, our physicians have focused their careers on studying and practicing neurourology. Why is this degree of specialization so important?

Lower urinary tract symptoms associated with neurological diseases involve intricate communications within the brain, central nervous system and urinary tract. As a result, evaluating patients with these disorders can be challenging. Our specialists extensive experience diagnosing these conditions and developing a treatment plan targeted at addressing each patient's unique set of symptoms.

For patients, this means they can count on receiving exceptional care from physicians who are recognized experts in the urological complications of neurological disease.

Leading-Edge Therapies

We use today's most advanced technologies and techniques, and sometimes we work closely with leading researchers to develop them. However, we recommend these therapies only when they are safe, clinically proven and most likely to produce the desired outcome—and a better quality of life—for the patient.

These innovations, which help many patients avoid complicated procedures, include:

• Oral prescription medications, which increasingly are producing better outcomes and fewer side effects.
• Successful injection therapies for incontinence and voiding dysfunctions, using well-known agents as well as newer therapies such as botulinum toxin (i.e. Botox)
• Biofeedback techniques and physical therapy
• Noninvasive and minimally invasive nerve-stimulation therapies, including sacral neuromodulation for incontinence and voiding dysfunctions