Ep. 335 Diagnosis & Management of Neurogenic Bladder with Dr. Benjamin Brucker

How do you decide if a neurogenic bladder is a safety problem or a quality of life problem for each patient, and how do you move from guideline risk categories to a real surveillance plan? On this episode of BackTable Urology, Dr. Anjali Kapur interviews Dr. Benjamin Brucker, professor of urology and director of neuro-urology at NYU Langone Health, about navigating neurogenic lower urinary tract dysfunction. They start with the AUA and SUFU guideline framework, covering history, physical exam, mobility, cognition, voiding diaries, and risk stratification to sort patients into low, unknown, or high risk. Dr. Brucker outlines the findings that move a patient between categories and the workup needed, from renal ultrasound and urodynamics to identifying unsafe storage pressures and elevated post-void residual.

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This podcast is supported byMedtronic

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Timestamps

00:00 - Introduction03:20 - Initial Evaluation Under the AUA and SUFU Guidelines05:39 - Risk Stratification and Surveillance13:08 - Role of Fluoroscopy in Urodynamics14:55 - Spinal Cord Injury and Detrusor Sphincter Dyssynergia17:35 - Multiple Sclerosis, Parkinson Disease, and Stroke23:13 - Cognitive and Functional Status in Therapy Selection25:16 - Neuromodulation in the Neurogenic Population29:07 - Catheter Management and Sphincterotomy35:49 - Medical Therapy, Chemodenervation, and Surgical Escalation42:50 - Asymptomatic Bacteriuria and Antibiotic Stewardship46:04 - Gaps in Practice and Research on the Horizon50:48 - Closing Remarks

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More about this episode

The conversation dives into the nuances of managing neurogenic bladder by underlying disease, from detrusor sphincter dyssynergia after spinal cord injury to the variable patterns in multiple sclerosis, Parkinson disease, and stroke. Dr. Brucker explains the role of videourodynamics, the importance of matching therapy to cognition and mobility, and how to counsel patients on medical therapy, neuromodulation, catheterization, and surgery. They discuss antibiotic stewardship for asymptomatic bacteriuria, gaps between guidelines and real-world care, and what new devices and bladder transplant might mean for the future. The episode closes with a reminder that management is about treating the whole person, not just the diagnosis.

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