By Ugur Yilmaz Anatolian, MD
Neurourology is generally managed by urologists who are very good at regulating symptoms with medications and controlling bladder activity and urinary function; however, there is a small substratum of patients who require further testing to understand their condition. Unfortunately, the advanced neurological diagnostic tests used for common neurological conditions are still experimental for conditions relating to genital urinary function. There is a huge need for research and standardization of tests in the field of neurourology.
Electrodiagnostic testing is often used to determine pathology for many neurologic conditions, such as carpal tunnel syndrome, peripheral neuropathy, or cervical radiculopathy. But there are no commensurate electrodiagnostic tests for the bladder, bowel, or sexual function. Standardized testing is crucial for diagnosing and treating certain neurourological conditions; however, electrodiagnostic testing relating to the genitourinary system is underdeveloped and requires further research. Without these advancements in the field of neurourology, some patients will be left underserved.
So why is there a gap in neurourological research? The main problem is that the nervous system of the genitourinary tract is fairly complicated, involving both the somatic and autonomic nerves. Autonomic nerves are difficult to test with electrodiagnostic tests. Another obstacle arises from the difficulty in accessing the deeper pelvic nerves. Additionally, researchers need to have a more profound understanding of neurophysiological tools in both urology and neurology to develop these tests. Lastly, because these diagnostic tests are not standardized, insurance providers will not cover the cost of performing these tests. Some labs explore experimental tests, but until they are standardized, they won’t be as beneficial for patients overall.
Fortunately, we can work to bridge this clinical gap by raising awareness about this issue and increasing support from research organizations like the National Institutes of Health (NIH). With enough support, we can push for more research at academic centers and in clinical practice. I also encourage neurologists to get involved in this type of research. At the end of the day, this research will improve the quality of life for our patients.
Ugur Yilmaz Anatolian, MD, has been a neurologist with TPMG Neurology in Newport News since 2014. He completed his residency training in Urology and came to the United States as a visiting professor of Urology. Dr. Anatolian completed four years of research, a clinical fellowship in Neurourology, an internship in medicine, residency training in neurology and a clinical neurophysiology fellowship at the University of Washington in Seattle. mytpmg.com
