Neurogenic bladder Dr Hussein Lafta urologist Neurogenic bladder
Neurogenic bladder Dr. Hussein Lafta. urologist
Neurogenic bladder It is group of functional disorder that affect the storage and or voiding function of the lower urinary tract. causes: I-dis. affecting brainstem e. g stroke, tumor, trauma, dementia. II-dis. affecting spinal cord e. g. trauma, tumor, III-dis. affecting peripheral nerves e. g. D. M, multiple sclerosis, trauma.
classification N. B. can be classify according to the level of inj. or dis. from the sacral center{S 2, 3, 4}: I-upper motor neuron lesion, which also called spastic, uninhibited detruser, hyper-. reflexiec, hypertonic II-lower motor neuron lesion also called : flacced, atonic, hypo-reflexiec
Upper motor neuron lesion Here the detruser ms. will contract whenever strech recepter send signals to the spinal cord{sacral center} this bec. The Inhibitory stimuli from higher center is lost. -the striated sphinctor may become spastic and contract instead of relaxing as the detruser contracts, resulting in bladder outlet obstruction{detruser-sphincter dyssynergia}. -this obstruction prevents effective bladder emptying and result in high-pressure voiding with residual urine, over time this condition may result in hydronephrosis, vesicoureteral reflux and eventually renal failure , if not treated.
Clinical features Frequency range from mild to sever according to the severity of inj. Urge incontinence: unability to delay voiding after percieving that the bladder is full. Recurrent u. t. i Signs and symptoms of ureamia
tratment -Anticholinergic drugs eg. oxybutanine -Augmentation cystoplasty to increase the capacity of the bladder. -Treatment of u. t. i
Lower motor neuron lesion There are two types of L. M. N. L: 1 -sensory type occurring in patients with long standing D. M, here the pt. may not sense that the bladder is full. 2 -motor type here the detuser ms. Paralysed so the pt. can not void{retention}.
treatment Sensory type: Timed voiding, pt. must go to the bathroom to void every 3 -4 hrs. , they also instructed to double voiding to insure that the bladder is empty. Motor type: -cholinergic drug eg. bethancole. -clean intermittent self-catheterization.
urodynamic Groups tests designed to study the bladder and the out {bladder neck and external sphinctor mechanism}during bladder storage and emptying, these tests consist of : -cystometry{measure the capacity , compliance , detruser contrality} -flowmetry{measure the speed of urine} 15 -20 ml/sec. in male 20 -25 ml/sec. in female. -external urinary sphinctor electromyography -urethral profile pressure.
Urological manifestation in multiple sclerosis M. S is unique in that the voiding problems change with time as the dis. Changes. The most common finding is unihibited bladder contraction , bladder sphinctor dyssynergia.
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