The situation in India remains dismal and gloomy as urological problems among Spinal Cord Injury (SCI) patients continue to be grossly neglected. In India, urinary complications still account for over 75 per cent of patients' repeated sickness and poor health, and they are the cause of death in 15 per cent of spinal injury patients.

Spinal injury often leads to common urinary problems, resulting in recurrent symptoms such as the inability to pass urine, the need to use a catheter or tube to manage the bladder, uncontrolled urine flow or incontinence, repeated urinary infections, and complications such as a deformed shrunken bladder, kidney and bladder stones, back pressure changes causing swelling of the kidneys, and eventual kidney failure.

These complications force frequent emergency visits to the hospital, requiring repeated admissions and costly advanced treatment. They impose a significant financial and social burden on the patients, families, and communities.

In over 95 per cent of patients, medical professionals vastly ignore the sexual and fertility problems faced by individuals with Spinal Cord Injury (SCI). The lack of awareness, training, and natural communication skills regarding such issues leads most doctors and nurses to refrain from taking the initiative to address them and assist their patients. Moreover, SCI patients themselves struggle to overcome their inhibitions and discuss these sensitive matters openly.

Additionally, religious and cultural factors further impede the free communication about sexual concerns. Consequently, a significant number of young men and women with SCI are compelled to lead an "asexual" life, which deeply affects their psychological well-being, causing impaired self-image and low self-confidence.

Neuro-urology, a specialized field that focuses on the nervous control of the urinary system and the management of urological conditions resulting from neurological disorders like spinal cord injuries, requires the establishment of more Centres of Excellence in India. These dedicated Neuro-urology Departments can play a crucial role in providing education and creating awareness, delivering protocol-based scientific care, and offering lifelong distance support through telemedicine. Moreover, they can provide state-of-the-art medical, minimally invasive, surgical, and neurostimulation and neuromodulation therapeutic treatments for the necessary indications.

Despite undergoing successful spine surgeries at various major spine centers, many spinal cord injury patients continue to face challenges related to neglected urinary and sexual health concerns. The lack of proper guidance and awareness about appropriate neuro-urological evaluation and management leaves them struggling.

The term 'Neglected Neurogenic Bladder' is used to describe SCI individuals who have not received even a single urologist's visit or basic urological evaluation in the past year or longer. This lack of care exacerbates their challenges when seeking treatment long after their initial injury, often leading to multiple complications.

Dr. Dinesh Suman, Director of Neuro-urology and SCI Andrology at the Indian Spinal Injuries Centre in New Delhi emphasizes -

"Nearly 1.5 million SCI patients in India urgently need awareness about the term 'Neglected Neurogenic Bladder,' which represents a significant neglect of urological and sexual health. Neglecting these aspects poses a substantial health concern. A healthy life begins with self-awareness and taking responsibility for one's own health through education and guidance.

Regrettably, SCI patients often find themselves lacking proper guidance to specialized neuro-urology services for adequate evaluation and management. An internal survey of out-patients who visited us after receiving spinal surgery from various other hospitals across the country revealed that nearly 90 per cent of them had never undergone detailed neuro-urological evaluation and management, despite ongoing concerns.

Therefore, it brings us satisfaction when young SCI men and women express joy after receiving discussions and guidance about sexuality and fertility concerns. This support rejuvenates them and energizes their pursuit of life. Many of our SCI patients have developed intimate relationships, got married, and now have their own children and families."

To maintain good health, avoid unnecessary complications, and have a good quality of life, every SCI person must understand the necessity of maintaining a safe and balanced urinary system. The principles of "Prevention, Preemption, and Prompt care" effectively work in ensuring good health and preventing avoidable complications through timely intervention and proactive measures.

India must give serious attention to urinary problems and related sexual health concerns among individuals with spinal cord injuries by providing dedicated comprehensive care without unnecessary duplication of efforts.