Question Title: NEUROGENIC BLADDER.......Neurological OR Urological???

We went to see a Neurologist who looked at tests results and did a neurological exam and said he doesnt think she has MS and nothing from exam warrants further testing. Neurologist says its a urological problem because nothing showed on tests. He also used the term hypo bladder and said nothing can be done except long term self cath, but to go ahead and see the urologist again, and that he would be sending a letter to the urologist saying he found nothing.

Her other symptoms are severe fatigue, back and flank pain, electrical charges up neck and skull, also on bottom of left foot. She also has alot of headaches, migraines, dizzyness, has fallen a few times per week when she feels that her leg just gives out and feels like rubber band. She also was told in the last two months she has a slight unintentional tremor. She says her insides feel like they are shaking. Neurologist said these are minor and nothing was found on neurological exam, and although he cant guarantee she doesnt have MS, he believes she should turn to her Urologist.

The questions that I have are:
1. If she has a neurogenic bladder, doesnt that mean that something neurological is the cause?
2. Is hypo bladder the same as neurogenic bladder?
3. Do you recommend we look further into a neurological problem even though exam and tests were negative?
4. Does this sound like it is just urological to you?
5. Any help or suggestions you could give us would be greatly appreciated.

Dear Margo:

1. The vast majority of adults with neurogenic bladder have an identifiable underlying neurological cause. Common causes include multiple sclerosis, spinal trauma, tethered cord syndrome, cauda equina syndrome or sacral rediculopathy from compression, infection, or infiltration, autonomic dysfunction from diabetes, other autonomic neuropathy, or multiple system atrophy, amongst various others. The vast majority of patients with these have an abnormal neurological examination. In children, in addition to cases occuring due to such causes, there are cases in which no neurological abnormality is identified. These patients have what is termed "non-neurogenic neurogenic bladder", or Hinman syndrome. Such children may have significant morbidity and may end up needing intermittent self-catheterization.

2. A "hypo" bladder probably means a hyporeflexic bladder. This is a description of the pattern of neurogenic dysfunction noted on cystometry.

3. Another neurological consultation for a second opinion would not hurt. Tests that may be useful, if not already done, include EMG, spinal tap, and autonomic function testing.

4. Can't say.

5. Suggest visiting a major tertiary academic medical center with reputed neurology and urology departments.