Neurourology + neurogenic bowel · UK
Neurogenic bladder and bowel management, by a specialist MDT.
Comprehensive, lifelong management for bladder and bowel dysfunction caused by spinal cord injury, spina bifida, MS, stroke, Parkinson’s and autonomic neuropathy - urodynamics, medication, botox, catheterisation, irrigation and surgery, decided by a proper team.
Why patients choose us
- 01
A neurourology and colorectal MDT
A consultant urologist with a neurourology interest, a colorectal surgeon who knows neurogenic bowel, a spinal rehab lead and a specialist continence advisor - sitting round the same table.
- 02
Upper tract protection comes first
Urodynamics, renal function and upper tract imaging are the spine of the plan. We protect the kidneys before we talk about pads.
- 03
Independent, and free
We are paid by no clinic, so the recommendation - CIC, botox, augmentation, Peristeen, MACE - is impartial and costs you nothing.
Indicative pricing
What specialist neurourology and bowel care costs in the UK.
NHS specialist spinal and neurourology centres fund most of this for eligible patients. Private ranges below for context - we quote firm figures once we understand the case.
In short
Neurourology consultation in our network: £250–£500, urodynamics and imaging usually within 1–2 weeks.
| Assessment or procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Neurourology consultation | £250–£500 | 45–60 min | Same visit |
| Video urodynamics + upper tract US | £900–£1,600 | 60–90 min | 1–2 weeks |
| Intravesical botulinum toxin (200U) for NDO | £1,000–£2,200 | Day case | 2 weeks |
| Suprapubic catheter insertion | £1,200–£2,500 | Day case | Same day |
| Transanal irrigation set-up (Peristeen / Navina) | NHS-prescribed | 60 min teach | Same visit |
| Malone antegrade continence enema (MACE) | £8,000–£14,000 | 2–3 h | 3–5 nights |
| Mitrofanoff catheterisable channel | £14,000–£22,000 | 4–6 h | 5–10 nights |
| Ileocystoplasty (bladder augmentation) | £15,000–£25,000 | 4–6 h | 7–14 nights |
| Artificial urinary sphincter (AUS) | £14,000–£18,000 | 2–3 h | 1–3 nights |
Prices vary by clinic, by which consultant does the case, by whether inpatient stay is needed, and by the specific implant or device. We confirm a firm quote within one working day.
The problem
The right team, the right investigations, the right paired plan.
Neurogenic bladder and bowel is usually managed one specialist at a time - urology this month, colorectal next year - with the kidneys quietly deteriorating in the background. We put the team round the table.
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Bladder and bowel, together
They share nerves, timing and quality-of-life goals. A plan that fixes one and ignores the other is a half plan.
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Kidney protection first
Video urodynamics and upper tract imaging drive the plan - because silent high-pressure storage is what damages kidneys.
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The full menu on the table
Medication, botox, CIC, SPC, Peristeen, MACE, Mitrofanoff, augmentation, AUS, SNM - we discuss all of it, not just the one the surgeon likes.
The journey
From enquiry to surveillance - what happens, in order.
One clinician from first message to review - with the MDT that sits behind them.
Phase 1 · Before assessment
Concierge, off-stage for you
Phase 2 · At the clinic
Consultation, investigations, MDT
Phase 3 · After
Lifelong surveillance
- 01
Before
You tell us what is going on
A short, confidential form. Neurological diagnosis, current bladder and bowel pattern, catheters or irrigation already in use, any recent UTIs or admissions.
- 02
Before
We come back with a plan
Within one working day: which investigations are needed first (urodynamics, renal US, MRI spine, anorectal manometry), which specialists to see, and an indicative cost.
- 03
Before
We arrange the assessments
Usually within one to two weeks. Diaries, bloods, imaging and urodynamics are sequenced so the MDT can decide, not guess.
- 04
At the clinic
Consultation and investigations
Full history and examination - including perianal sensation, anal tone and S2–S4 dermatomes - and the urodynamic study that decides bladder type.
- 05
At the clinic
The MDT recommendation
Bladder strategy (antimuscarinics, mirabegron, botox, CIC, SPC, Mitrofanoff, augmentation, AUS) paired with a bowel strategy (bowel programme, Peristeen, MACE, SNM, stoma).
- 06
At the clinic
Training and equipment
CIC teaching by a specialist continence advisor, transanal irrigation set-up, or admission planning for surgical options - whichever the plan needs.
- 07
After
Lifelong surveillance
Annual renal function and upper tract imaging, urodynamics as indicated, review of pads, catheters and irrigation, and a plan for autonomic dysreflexia if you are at risk.
Typical end-to-end: 2–4 weeks from enquiry to MDT plan. Surveillance: lifelong.
When it helps
When specialist neurogenic bladder and bowel care is the right step.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
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Spinal cord injury
Traumatic or non-traumatic SCI at any level - bladder and bowel patterns depend on level and completeness. T6 and above brings autonomic dysreflexia risk.
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Spina bifida and tethered cord
Congenital or acquired - lifelong bladder and bowel management, often from childhood. Upper tract protection is the priority.
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Multiple sclerosis
Urgency, frequency, retention and constipation are common as MS progresses. Patterns change over time and need re-assessment.
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Stroke, Parkinson’s, cerebral palsy
Central neurological disease often produces detrusor overactivity, urgency incontinence and slow-transit constipation.
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Autonomic and peripheral neuropathy
Diabetic or other autonomic neuropathy can cause a large, poorly emptying bladder and sluggish bowel - often quietly, until infections or stones present.
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Cauda equina and pelvic nerve injury
Post-surgical, post-radiotherapy or traumatic pelvic nerve injury - retention, incontinence and faecal incontinence in combination.
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Refractory neurogenic detrusor overactivity
Antimuscarinics and mirabegron have failed or are not tolerated - intravesical botulinum toxin is the next NICE-recommended step.
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Red flag: autonomic dysreflexia
Sudden headache, sweating and hypertension in a spinal cord–injured patient is a medical emergency - usually a blocked catheter or a full bowel. Call 999.
Management options
The full menu - bladder and bowel.
What each option actually involves - and which fits which pattern of neurogenic dysfunction.
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Antimuscarinics + mirabegron
First-line medical therapy for detrusor overactivity - oxybutynin, solifenacin, tolterodine, mirabegron. Titrated against side effects and post-void residual.
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Intravesical botulinum toxin (200U)
NICE-approved for neurogenic detrusor overactivity refractory to medical therapy. Cystoscopic injection under LA or GA, repeated every 6–9 months.
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Clean intermittent self-catheterisation
The gold-standard for a bladder that will not empty - taught by a specialist continence advisor and protective of the upper tracts.
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Suprapubic catheter
A long-term drainage option when CIC is not feasible. Lower urethral complication rate than long-term urethral catheters.
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Mitrofanoff and bladder augmentation
A catheterisable channel - often with an ileocystoplasty - creates a continent, low-pressure reservoir that empties on your terms.
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Artificial urinary sphincter / male sling
For neurogenic sphincter deficiency with adequate bladder capacity - mechanical continence when medical therapy is not enough.
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Transanal irrigation (Peristeen, Navina)
Pump-assisted rectal irrigation transformed neurogenic bowel management - highly effective, NHS-prescribed, huge quality-of-life gain.
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MACE and sacral neuromodulation
Malone antegrade continence enema for antegrade bowel flushing, or SNM for refractory bladder and bowel dysfunction where anatomy allows.
Our vetted UK network
A small panel of neurourology and colorectal MDTs, we picked them.
Consultant-led teams in London, Manchester, Birmingham and the major spinal centres. Not listed publicly - introductions are made privately, once we understand your case.
Selection criteria
How we choose every team in our network.
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Consultant urologists with a declared neurourology interest
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Colorectal surgeons who routinely manage neurogenic bowel and MACE
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Specialist continence advisors for CIC, SPC and irrigation training
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Access to video urodynamics, upper tract imaging and anorectal manometry
Safety and long-term care
What to plan for over the long term - honestly.
Neurogenic bladder and bowel is a lifelong condition. The things worth planning are kidney protection, sensible antibiotic use, red-flag awareness and quality-of-life goals that get tracked.
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Upper tract protection is the point
A high-pressure bladder damages kidneys silently. Urodynamics and regular upper tract imaging are non-negotiable, whatever else the plan looks like.
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UTIs are common, and often over-treated
Bacteriuria on a catheter or CIC regimen is expected. We treat symptomatic infection, not the dipstick - antibiotic stewardship matters.
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Autonomic dysreflexia is a medical emergency
For SCI at T6 and above, a blocked catheter or full bowel can trigger a hypertensive crisis. Sit up, remove the trigger, call 999 if it does not settle.
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Reservoir stones and metabolic issues
Augmented bladders and continent reservoirs need long-term surveillance for stones, mucus and electrolyte changes.
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Skin around catheters and stomas
SPC exit sites, MACE stomas and pad-related skin need proactive care - a specialist nurse makes a real difference.
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Bowel programme first, surgery later
A properly implemented bowel programme with transanal irrigation resolves most neurogenic bowel - MACE and colostomy are for genuine failure of conservative care.
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Quality of life is a legitimate goal
Continence, dignity, sleep and time off the toilet are worth measuring. We track them as seriously as the imaging.
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The plan changes as the disease changes
MS, Parkinson’s and long-term SCI shift over time. Re-assessment every one to two years - sooner if things change - is standard.
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Red flags
Sudden retention, haematuria, flank pain, fever, or autonomic dysreflexia symptoms warrant same-day urgent review - not a routine appointment.
Reading your MDT letter
Your MDT letter in four parts. Read the last one first.
Whichever combination of treatments was agreed, the MDT letter you receive keeps to the same shape.
A quiet reminder
Neurourology language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the letter before your next appointment, just ask.
- 01 Header
Neurological diagnosis and bladder/bowel type
Underlying diagnosis, level and completeness (for SCI), and the urodynamic classification - detrusor overactivity, underactivity, dyssynergia, sphincter deficiency.
- 02 Findings
Investigations and upper tract status
Video urodynamics numbers, renal function, upper tract imaging, anorectal manometry - the objective evidence the plan is built on.
- 03 Plan
Bladder and bowel management strategy
The paired plan: medication, catheterisation regimen, botox schedule, irrigation, surgical options - with who does what and when.
- 04 Impression
Surveillance, red flags and QoL goals
Read this first: how often we re-image the kidneys, when to seek urgent help, and the continence and quality-of-life goals we are tracking.
Recognised by major UK insurers
Cover for neurourology and neurogenic bowel management varies by insurer and by specific intervention - botox, implants and reconstructive surgery are usually funded when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about neurogenic bladder and bowel management.
Quick answers on urodynamics, botox, irrigation, MACE, Mitrofanoff and autonomic dysreflexia.
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What is neurogenic bladder and bowel dysfunction?
It is bladder and bowel dysfunction caused by a neurological condition - spinal cord injury, spina bifida, MS, stroke, Parkinson’s, cerebral palsy, cauda equina or autonomic neuropathy. The pattern depends on the level and nature of the nerve problem, and it usually needs a lifelong, individualised plan.
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Why is urodynamics so important?
Because how a neurogenic bladder behaves under pressure decides the plan - and the risk to your kidneys. A bladder that stores at high pressure will damage the upper tracts silently. Video urodynamics tells us whether the priority is to relax the bladder, empty it, or both.
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What is intravesical botulinum toxin, and does it work?
It is 200 units of botulinum toxin injected into the bladder wall through a cystoscope. NICE recommends it for neurogenic detrusor overactivity that has not responded to antimuscarinics or mirabegron. It works well - most patients regain continence - and is repeated every six to nine months.
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What is transanal irrigation (Peristeen, Navina)?
A small pump gently instils warm water into the rectum via a soft catheter or cone, which then evacuates the lower bowel in a controlled, predictable way. It is life-changing for neurogenic bowel and is NHS-prescribed for eligible patients.
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What is a Mitrofanoff, and who is it for?
A Mitrofanoff is a catheterisable channel - typically the appendix - from the bladder (often with an augmentation) to a small stoma at the umbilicus. It lets you catheterise on your own terms when the urethral route is not workable, and can be combined with bladder neck closure for continence.
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What is a MACE?
A Malone antegrade continence enema uses the appendix (or a Monti tube) as a catheterisable channel from the caecum to the abdominal wall. You flush the bowel antegrade - usually daily or alternate days - and become reliably continent between flushes. Excellent option for severe neurogenic bowel.
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What is autonomic dysreflexia and why does it matter?
In spinal cord injury at T6 and above, a stimulus below the level of injury - a blocked catheter, a full bowel, a pressure sore - can trigger a sudden dangerous rise in blood pressure with headache and sweating. It is a medical emergency: sit up, remove the trigger, and call 999 if it does not settle.
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How much does specialist neurourology and bowel management cost privately?
A consultation is £250–£500. Video urodynamics with upper tract US is £900–£1,600. Intravesical botox is £1,000–£2,200. MACE is £8,000–£14,000, Mitrofanoff £14,000–£22,000, bladder augmentation £15,000–£25,000, AUS £14,000–£18,000. NHS specialist spinal and neurourology centres cover most of this for eligible patients.
Related treatments
Looking for something else?
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Mitrofanoff
Catheterisable channel for continent bladder emptying.
Learn more -
Neobladder reconstruction
Continent urinary reconstruction after cystectomy.
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Artificial urinary sphincter
Mechanical continence for sphincter deficiency.
Learn more -
Male sling
Sling surgery for post-prostatectomy incontinence.
Learn more -
Neuromodulation
Sacral nerve stimulation for bladder and bowel.
Learn more -
All tests and procedures
Every test and procedure we arrange.
Learn more