Clinical bladder evaluation: A new, cost-effective, clinical method for neurogenic bladder evaluation and rehabilitation

Abstract

Clinical bladder evaluation is a cost-effective, non-invasive method for diagnosing and managing urinary dysfunction, particularly in patients with neurogenic bladder or other impairments. This process aims to assess bladder capacity, storage, and voiding functions through simple, realistic, and resource-friendly approaches. It involves a structured series of steps, from history-taking and physical examination to bladder-emptying procedures, monitoring urine leaks, assessing reflex voiding, measuring post-void residual (PVR), and calculating total bladder capacity. These evaluations help differentiate between upper motor neuron and lower motor neuron bladder dysfunction, providing critical insights for tailored management. The interpretation of findings focuses on identifying bladder type, assessing leak timing and volume, evaluating reflex voiding, and measuring PVR and total bladder capacity. The results guide interventions such as timing self-clean intermittent catheterization, adjusting fluid intake, and using bladder diaries to monitor patterns. Clinical bladder evaluation is particularly advantageous in low-resource settings, as it avoids the risks and costs associated with urodynamic studies while reflecting real-life patient conditions more effectively. Despite its benefits, no validation studies currently exist for clinical bladder assessment, and its parameters, like maximum voided volume, remain underexplored compared to urodynamic measures. Given the accessibility, affordability, and practicality of this approach, it holds promise for widespread application, especially in primary care settings and among economically disadvantaged populations. This editorial describes the process step-by-step and highlights its role in improving patient outcomes while minimizing complications.

Keywords: Clinical bladder evaluation; Neurogenic bladder; Post-void residual; Upper motor neuron bladder; Lower motor neuron bladder; Bladder capacity; Incontinence; Low-resource settings; Urodynamics alternative

Core Tip: Clinical bladder evaluation is a cost-effective, non-invasive, and practical method for diagnosing and managing urinary dysfunction, particularly in low-resource settings. It avoids instrumentation-related risks, aligns with real-life patient conditions, and provides essential insights into bladder function, enabling tailored management strategies like self-catheterization, fluid intake adjustment, and use of bladder diaries. This approach is especially beneficial for patients with neurogenic bladder or those in economically disadvantaged regions, offering a feasible alternative to urodynamic studies.