Urologist referred me to a Neurologist. What to expect?

[MountainLake622]

I've seen urologists for years, so Im pretty used to all the standard exams and tests and procedures in urology.

I'm being treated for overactive bladder, which has been exacerbated in recent years by BPH. I have urinary frequency and urge incontinence, which has gotten worse over the years. Prior to that I had and continue to have steady leakage.

My incontinence symptoms have stabilized but not improved. I started using a diaper at night about 8 years ago. About four years ago I started wearing a diaper during the day as well, instead of pullups or pads.

Anyway, I am just trying to mentally prepare for my upcoming neurology exams and tests. I am just wondering what to expect. The person I am seeing is a Neuro-Urologist. So I guess they have training in both areas.

I have a Nerve Conduction Test with EMG in a couple weeks, then my intake appointment with the Neurologist.

Ive done some Google research obviously but I am just kind of wondering what these kinds of appointments and procedures are like, from others who have experienced them first hand.

Thank you!

 

[justej]

I’ve actually been to a neurologist for incontinence so unfortunately I can’t offer any help but I’m interested In seeing how it goes though. Good luck and if you can give us an update!

 

[MichaelDahlke]

Hello MoutainLake,

The fact that an overactive bladder can be related to the prostate is not so unusual at first. In principle, two questions arise for me:

- What has been done so far about the prostate problem?
- How does the urologist come after 8(!) Years later to bring in a neurologist...?

I mean honestly - if this is a neurological problem - which it can be, then after 8 years the chances of getting it under control again are rather manageable...

To be honest, I'm also amazed that they want to do a nerve conduction test. Normally, an MRI of the head and spine is first made. In the case of urge incontinence, preferably the cervical spine.

If something is found there, you will possibly do a SEP to clarify whether nerve lines in the spine are disturbed. Depending on what you find there, it can continue differently. However, you will usually only find something with the SEP if there are also further failures such as paresis of the legs or arms.

If foci of inflammation are found with the MRI, or the SEP provides a pathological result, a spinal cord puncture may also be arranged to be able to rule out MS and polyneuropathy.

An NCT is not suitable for testing very long nerve pathways. Usually you do this, for example, on the hand or on the foot if you want to determine whether a spinal nerve compression is to blame for pain, numbness or paralysis. I had the examination with needles on my hand and with electrodes on my foot and found it not particularly bad compared to other examinations.

In urology, this is also available for the pelvic floor - but at least in Germany it is rarely performed - and only if there is evidence of spinal damage in the lower lumbar spine area by an MRI.

The point is: If there is spinal damage, something must be done as soon as possible. The plot horizon here is hours, because once the nerves of the spine have perished, you can conjure them up badly and they usually don't grow back either.

Long story short: Of course you can measure and investigate all this. But the decisive question should always be: Which therapy results from the result?

If there is an answer to this - e.g. the examination serves to exclude more serious diseases, this is OK. If not - from my point of view, you can also do without it...

 

[MountainLake622]

Hello! Thanks for your response!

I did end up having the Nerve Conduction Test, it wasnt so bad.

It was somewhat inconclusive, indicating a compressed nerve in my neck but that is likely not contributing to my urinary symptoms. I have been having some pins and needles tingling in my hands and feet I think thats why they ordered the NCT.

I did see the neurologist for a follow up in his office today, 3 months after the NCT. He did mention an MRI would be the best option to find out what's going on.

But the way insurance works here, they wont pay for that, you have to have an X ray first.

So today I got a cervical and lumbar x ray

 

[MountainLake622]

Oh, and in terms of my prostate, I take Taladafil and Myrbetric to relax my pelvic floor and bladder muscles. My urologist suggests a TURP procedure, but I haven't scheduled it yet. I feel like there are some risks and sexual side effects. Also there is no guarantee it would fix my incontinence issues since Ive had them for so long and they predate my BPH diagnosis.

 

[MichaelDahlke]

Hello MountainLake

So that the TURP will fix the incontinence is of course not guaranteed - but also not unlikely if there are no neurological problems.

Depending on how big the prostate is, there are different methods to perform such an operation. If you want to avoid a retrograde ejaculation, which usually occurs after a TURP with a sling or laser, I would look for a clinic that also offers the REZUM method.

Here I would ask if you are eligible for this method, because unlike most other methods it does not damage the inner sphincter. Whether this works for you or not depends in particular on the size of the prostate and the type of obstruction. This should be clarified beforehand with a urethral mirror and ultrasound.

Doing nothing at this point is usually not a good idea, because at some point your bladder can no longer compensate for the obstacle. The muscle then breaks down (trebaculates) and this can in the worst case also lead to a flaccid bladder, which you can only empty by means of ISC.

Therefore, I would gradually approach the problem: First exclude neurological causes (MRI and urodynamic examination) and then tackle the prostate problem.

If the UD and the MRI point out a neurological problem, you have to discuss it again with the urologist, because if the OAB is not caused by the prostate but neurological, it may also be that the incontinence becomes stronger after the operation - because then the "pressure reducer" prostate is better permeable again.

In any case, however, too high bladder pressures should be prevented in the long term. Currently, you can achieve this through the Myrbetric. However, you should discuss this medication again with your doctor, because with BPS this alone can be contraindicated.

If you dampen the bladder with Myrbetric and at the same time there is an obstruction, e.g. due to an enlarged prostate, this can lead to urinary retention and residual urine because the bladder can no longer exert enough force to convey the urine out.

Therefore, in the case of BPS, one should consider to take an alpha-1A adrenoreceptor antagonist such as tamsulosin. But as I said, this is a topic for the urologist.

Best regards
Michael