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. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Medtronic --- Timestamps 00:00 - Introduction 03:20 - Initial Evaluation Under the AUA and SUFU Guidelines 05:39 - Risk Stratification and Surveillance 13:08 - Role of Fluoroscopy in Urodynamics 14:55 - Spinal Cord Injury and Detrusor Sphincter Dyssynergia 17:35 - Multiple Sclerosis, Parkinson Disease, and Stroke 23:13 - Cognitive and Functional Status in Therapy Selection 25:16 - Neuromodulation in the Neurogenic Population 29:07 - Catheter Management and Sphincterotomy 35:49 - Medical Therapy, Chemodenervation, and Surgical Escalation 42:50 - Asymptomatic Bacteriuria and Antibiotic Stewardship 46:04 - Gaps in Practice and Research on the Horizon 50:48 - Closing Remarks --- 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. --- Resources Neurogenic Lower Urinary Tract Dysfunction: AUA/SUFU Guideline https://www.auanet.org/guidelines-and-quality/guidelines/adult-neurogenic-lower-urinary-tract-dysfunction Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation. J Urol. 2021 https://doi.org/10.1097/JU.0000000000002235 Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-up. J Urol. 2021 https://doi.org/10.1097/JU.0000000000002239 Vurture G, Peyronnet B, Palma JA, et al. Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease. Int Neurourol J. 2019. https://doi.org/10.5213/inj.1938086.043 Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). https://sufuorg.com/ American Urological Association (AUA) https://www.auanet.org/ First human bladder transplant, UCLA Health, 2025. https://www.uclahealth.org/news/release/first-human-bladder-transplant-performed-ucla Dr. Benjamin Brucker, NYU Langone Health physician profile https://nyulangone.org/doctors/1235295619/benjamin-m-brucker Dr. Benjamin Brucker, BackTable Urology contributor page https://www.backtable.com/shows/urology/contributors/dr-benjamin-brucker Dr. Anjali Kapur, BackTable Urology contributor page https://www.backtable.com/shows/urology/contributors/dr-anjali-kapur --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app