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PubMed1981

Pharmacological studies of the uninhibited neurogenic bladder. III. The influence of adrenergic excitatory and inhibitory drugs on the cystometrogram of neurological patients with normal and uninhibited neurogenic bladder.

In order to elucidate the sympathetic activity of the uninhibited neurogenic bladder, controlled cystometry before and during the influence of alpha- and beta-adrenergic agonists and antagonists was performed on patients with normal and uninhibited neurogenic bladder. Alpha-agonist increased the pathological findings in the cystometrogram of the uninhibited bladder with increase in intravesical pressure, decrease in capacity and increase in the amplitude of the uninhibited contraction, but had no effect whatsoever on the normal bladder. Alpha-antagonists improved the uninhibited bladder with decrease in intravesical pressure, increase in capacity and decrease in amplitude of the uninhibited contraction, and decrease in intravesical pressure in normal bladder. Beta 2-agonist improved the uninhibited bladder too, but was proved to be inactive on the normal bladder. Unselective beta- and selective beta 1-antagonists deteriorated the uninhibited bladder and had only minor effect on the normal bladder. The decreased capacity and forcible uninhibited detrusor contraction seem to be due to a reduction of inhibitory beta-adrenergic impulses as well as an increased contractile alpha-adrenergic action on the bladder wall in uninhibited neurogenic bladder.

Adrenergic Fibers↗
PubMed1981

Pharmacological studies of the uninhibited neurogenic bladder. II. The influence of cholinergic excitatory and inhibitory drugs on the cystometrogram of neurological patients with normal and uninhibited neurogenic bladder.

In order to elucidate the parasympathetic activity of the uninhibited neurogenic bladder, controlled cystometry before and during influence of cholinergic and anticholinergic drugs has been performed on patients with normal and uninhibited neurogenic bladder. Cholinergic stimulation proved to increase the intravesical pressure to a great extent; to a higher degree in the normal than in the uninhibited bladder. In two patients with normal bladder, uninhibited detrusor contractions were induced by cholinergic stimulation. Cholinergic inhibition had only minor influence on the intravesical pressure during the filling phase. Opposite effects were obtained on the uninhibited detrusor contractions which are regarded as a part of the expulsive phase. Cholinergic stimulation increased the amplitude of the uninhibited bladder to some degree, but cholinergic inhibition markedly reduce the amplitude. Conclusively, the uninhibited neurogenic bladder is at least partly caused by an overactivity in cholinergic stimulation.

Adult↗
PubMed1978

Transurethral bladder neck operation in neurogenic bladder.

86 adults with bladder outlet obstruction and neurogenic bladder underwent bladder neck resection or incision to establish effective vesical emptying or damping of detrusor reflex activity. Follow-up examinations revealed a good effect on flow, reflux and hydronephrosis, infection rate and symptoms such as frequency, dysuria, nocturia and urgency. Since 1974, bladder neck incision is preferred; resection remains for selected cases only.

Adolescent↗
PubMed1997

The nature of detrusor bladder neck dyssynergia in non-neurogenic bladder dysfunction.

There have been two major opinions on the pathology or nature of the bladder neck contracture. One is an organic fibrosis, and the other is an accentuated sympathetic nervous function, or detrusor bladder neck dyssynergia. The existence of active detrusor bladder neck dyssynergia in neurogenic bladder was reported in a urodynamical manner using microtip transducer catheters. However, it has not been confirmed whether or not detrusor bladder neck dyssynergia is responsible for bladder neck contracture in patient without neurogenic bladder. The present study was designed to determine by means of video urodynamic study whether or not bladder neck contracture would be of the same nature as detrusor bladder neck dyssynergia in non-neurogenic bladder subjects. The study included 32 male subjects of 16-84 years old (average 52.3): 17 bladder neck contracture subjects including 7 subjects associated with minimum complications (4 with trapped benign prostatic hyperplasia and 3 with incomplete neurological lesion) and 15 non-bladder neck contracture subjects (10 healthy volunteers, 2 chronic prostatitis, 3 prostatodynia). A 5-microtip transducer catheter was used to measure the pressure in the bladder and at the bladder neck, the external urethral sphincter and the bulbous urethra during voiding. Proper localization of the transducers was done with an image intensifier. Bladder outlet obstruction localized at the bladder neck (diameters smaller than 0.75 cm) on voiding cystourethrogram was defined as bladder neck contracture. Detrusor bladder neck dyssynergia was defined where pressures were higher at the level of bladder neck than in the bladder during detrusor contraction. An alpha-blocker, terazosin hydrochloride (0.5 mg, b.i.d., two weeks), was orally administered to subjects judged to have detrusor bladder neck dyssynergia by the above methods for the purpose of confirming whether detrusor bladder neck dyssynergia was really due to accentuated sympathetic nervous function. Detrusor bladder neck dyssynergia was found in seven cases with bladder neck contracture: 6 cases with bladder neck contracture with minimum complications and only 1 case with bladder neck contracture without complications (p < 0.01). Detrusor bladder neck dyssynergia was found at the beginning and ending of micturition, but not at maximum flow. In six cases with detrusor bladder neck dyssynergia, the condition disappeared after terazosin. In conclusion, detrusor bladder neck dyssynergia was not thought to be a major factor of voiding dysfunction in bladder neck contracture in non-neurogenic bladder. In the presence of sympathetic hyperactivity or in cases with increased number of alphareceptors, detrusor bladder neck dyssynergia occurs, being predominantly noted in trapped benign prostatic hyperplasia and neurological disorder patients.

Adolescent↗
PubMed1981

Pharmacological studies of the uninhibited neurogenic bladder. I. The influence of repeated filling and various filling rates on the cystometrogram of neurological patients with normal and uninhibited neurogenic bladder.

The influence on the cystometrogram of repeated filling and varying filling rates was studied in two groups of neurological patients, one with normal and one with uninhibited neurogenic bladder. A technique which permits an even bladder filling and a continuous recording of the intravesical pressure was used. The effect of repeated bladder filling without interval at a rate of 50 ml per min resulted in the following findings: In the normal bladder the intravesical pressure decreased at the second filling in three of the five patients. The bladder capacity remained unchanged in four of the five patients. In the uninhibited bladder, only a slight tendency to pressure decrease could be observed at the second filling in the 14 patients studied. The bladder capacity increased significantly (14 patients), while the amplitude of the uninhibited contraction was reduced (17 patients). These changes of the cystometric parameters cold be avoided in both groups when an interval of 20 min was interposed between the fillings. Varying filling rates (range 10 to 90 ml per min) resulted in the following findings: The normal bladder responded to higher filling rates partly with pressure increase (3 out of 6 patients), partly with pressure decrease (2 patients) or with unchanged pressure (1 patient). The capacity was independent of the filling rate. In the uninhibited neurogenic bladder, the pressure response to higher filling rates was either unchanged (11 out of 16 patients), higher pressure (3 patients) or a reduced pressure (2 patients). The capacity of the uninhibited bladder was not influenced by the filling rate in 10 out of 16 patients. The capacity increased at higher filling rates in four patients, and decreased in one. The amplitude of the uninhibited detrusor contraction was not influenced by the filling rate in nine out of 18 patients. The amplitude increased in five and decreased in four patients at higher filling rates. The present results show that an interval of at least 20 min has to be interposed between the fillings when cystometry with high and non-physiological filling rates is used for pharmacological studies. Otherwise, non-specific results will frequently be obtained. The influence of the rate of filling is of less importance as long as one and the same rate is used in the same experiments.

Adult↗
PubMed1975

Evaluation of a magnetic bladder pump for neurogenic bladders.

A new bladder pump prosthesis has been designed and evaluated in the normal dog bladder. This encompasses a magnetic pump located subcutaneously with internal silicone catheters from bladder to the urethra. The pump is powered from a hand-held activator which is magnetically coupled externally across the skin. This pump was evaluated in 12 dogs for an average of 65 days and provided adequate emptying of the bladder without alteration of the normal urinary tract or pump malfunction. The potential and limitations of this new approach are discussed.

Animals↗
PubMed1986

[A study of functional recovery of urination and defecation by modified sero-muscular ileal flap fixation to the bladder in patients with neurogenic bladder].

Between 1978 and 1985, 72 patients with urinary and defecatory dysfunction due to neurogenic bladder associated with myelodysplasia (57), spinal cord injury (11), and other causes (4) were treated with modified sero-muscular ileal flap fixation to the bladder (modified IFFB). They were followed from 1 to 88 months (mean: 36.3 months). This operative procedure was attempted to recover urinary and defecatory function. Sixty-four patients underwent urodynamic studies before and after the modified IFFB. On urodynamic evaluation, bladder capacity was not decreased, voiding time was diminished, and average urine flow rate was significantly improved after the modified IFFB. Patients who were followed at least 6 months after the modified IFFB showed the following results. Urinary substitute sensation appeared in 57 out of 59 patients (96.6%) and fecal substitute sensation in 34 (57.6%). Urinary incontinence improved in 38 out of 42 patients (90.5%), disappearing completely in 19 (45.2%). Constipation improved in 26 of 59 patients (44.1%). The upper urinary tract improved in 22 renal units, remained unchanged in 90 renal units, and deteriorated in 6 of the 118 renal units. Operative complications were encountered in 6 out of 72 patients (8.3%). The modified IFFB procedure does not appear to be suitable for the low compliance bladders with high grade VUR or for young women who desire pregnancy in the future.

Adult↗
PubMed1992

Ambulatory monitoring of bladder pressure in low compliance neurogenic bladder dysfunction.

Upper tract dilatation is an important complication of neurogenic bladder dysfunction. Risk factors include incomplete bladder emptying with large residual volumes of urine and high tonic increases in bladder pressures during artificial filling. However, on natural bladder filling many of these patients do not have high tonic increases in detrusor pressures. We compared conventional urodynamic studies with ambulatory monitoring during natural bladder filling in 66 patients with low compliance neurogenic bladder dysfunction. There were marked differences in the tonic increase in bladder pressure during filling and in compliance during artificial bladder filling compared with ambulatory monitoring. Faster filling rates during artificial filling resulted in greater end filling pressures and lower compliance but the lowest increases in bladder pressure were found during ambulatory monitoring with natural bladder filling. During natural bladder filling significantly more patients had phasic changes in detrusor pressure; a high intensity of phasic activity during ambulatory monitoring correlated with high end filling pressures during artificial bladder filling. Upper tract dilatation was associated with large volumes of residual urine, high resting bladder pressures and low bladder compliance on filling at 100 ml. per minute. However, upper tract dilatation was most strongly associated with high intensity phasic pressure activity during natural bladder filling in combination with high residual urine volumes and high resting bladder pressures. On multivariate statistical analysis the intensity of phasic pressure activity during ambulatory monitoring was the best discriminator between patients with dilated and normal upper tracts. Our study has highlighted important differences in the results obtained by artificial filling cystometry and ambulatory monitoring during natural bladder filling. In particular, high increases in pressure did not occur during natural bladder filling, apparently being replaced by phasic activity. Within this group of patients who had the high risk factor of low bladder compliance measured during artificial bladder filling, a combination of greater residual urine volumes, greater resting pressures and greater phasic activity during natural bladder filling was found in patients with upper tract dilatation.

Adolescent↗
PubMed1991

Bladder augmentation in patients with neurogenic bladder and vesicoureteral reflux.

Current treatment of noncompliant neurogenic bladder associated with significant vesicoureteral reflux that is refractory to intermittent self-catheterization and anticholinergic therapy includes bladder augmentation coupled with a procedure to eliminate reflux. Antireflux surgery is often difficult in such a clinical setting. The diseased and thickened detrusor makes reimplantation into the bladder difficult, and successful reimplantation into the intestinal component is tricky and time-consuming. Augmentation alone was done in 14 patients with significant vesicoureteral reflux in the face of a noncompliant, high pressure neurogenic bladder. No effort was made to correct reflux surgically because, in theory, reflux is secondary to abnormal bladder pressure. Of the 13 patients who have had adequate evaluation with postoperative cystograms 12 no longer have reflux. The reflux in the remaining patient has improved from grade IV to grade II. Postoperative cystometric examination in 12 patients demonstrated low pressure and adequate volume. Correction of bladder dynamics alone reversed the reflux. Conversely, persistence of reflux postoperatively is an indication that augmentation has not successfully returned the bladder to a low pressure reservoir. Our experience indicates that antireflux procedures are not routinely needed in this group of patients.

Adolescent↗
PubMed2004

The M2 muscarinic receptor mediates in vitro bladder contractions from patients with neurogenic bladder dysfunction.

Bladder muscle specimens from seven patients with neurogenic bladder dysfunction were analyzed to determine whether the muscarinic receptor subtype mediating contraction shifts from M(3) to the M(2) subtype as found in the denervated, hypertrophied rat bladder. Seven bladder specimens were analyzed from six female and one male patients. Six of the patients had traumatic cervical spinal cord injuries (C(4)-C(7)), and the other patient had an L(1) congenital myelomeningocele. This was compared with results from bladder specimens obtained from eight organ transplant donors. The affinities of three subtype-selective muscarinic receptor antagonists for inhibition of carbachol-induced contractions were determined. The affinity of the M(3) selective antagonists darifenacin or p-fluoro-hexahydrosiladifenadol (p-F-HHSiD) was determined in six of the seven spinal injury patient specimens. The affinity was consistent with M(2)-mediated contractions in four of these six specimens, intermediate between M(2) and M(3) in one specimen, and within the M(3) range in one specimen. The other specimen, tested only with the M(2) selective antagonist methoctramine, showed an M(3) affinity. In the organ donors, the affinity of p-F-HHSiD was within the M(2) range for six of seven specimens, whereas the affinity of darifenacin was within the M(3) range for five of six and intermediate between M(2) and M(3) for the other specimen tested. The affinity of methoctramine in both organ donor specimens tested was within the M(3) range. Whereas normal detrusor contractions are mediated by the M(3) receptor subtype, in patients with neurogenic bladder dysfunction as well as certain organ transplant donors, contractions can be mediated by the M(2) muscarinic receptor subtype.

Adolescent↗
PubMedDate not supplied

Neurogenic bladder.

Management of neurogenic bladder in children is challenging for the practising clinician. This involves consideration of multiple and diverse factors which must be balanced in an ever changing environment. Also the dynamics of a child's growth must always be considered because it contributes to the ongoing instability of the neurologic lesion. Prevention and proactive approaches have become the mainstay of the therapy. It is not appropriate to wait for problems to occur before treating these children, because changes that take place may not be reversible, even if they are detected early. The clinician should be aware of the various clinical presentations of neurogenic bladder dysfunction in children and familiarize themselves with the modes of treatment available. Long term follow-up is mandatory. Finally, the value of streamlining these children into society at an early age must always be considered.

Child↗
PubMed1999

Outcome of the bladder cooling test in children with neurogenic bladder dysfunction.

PURPOSE: We evaluated the diagnostic use of the bladder cooling test in children with neurogenic bladder dysfunction. MATERIALS AND METHODS: We performed 201 bladder cooling tests in 65 female and 43 male patients 5 days to 17 years old, including 70 with myelomeningocele, 12 with high spinal lesions, 9 with sacral spinal lesions and 17 with encephalopathy of various types. At the end of routine cystometry we rapidly infused body temperature saline to approximately a third of cystometric capacity, followed by the same volume of saline at 4 to 8C. The test was considered positive when a detrusor contraction greater than 30 cm. water was evoked by the cold but not the warm infusion. RESULTS: The bladder cooling test was positive in 37 children younger than 4 years, at which age it is normally positive. The test was negative in only 2 patients, indicating a complete lower motor neuron lesion. It was positive in 34 of the 57 children older than 6 years, at which age it should be negative. Thus, the positive bladder cooling test confirmed neurogenic bladder dysfunction. Four of the 20 children with a negative test voided normally, while the remainder had no voiding contractions, suggesting a nonfunctional spinal sacral reflex arch to the bladder. CONCLUSIONS: The bladder cooling test is a simple, reliable assessment that may serve to demonstrate a functional sacral reflex arch in young patients without voiding contractions or confirm a suspected lower motor neuron lesion. It may be used longitudinally to demonstrate changes in bladder function with growth.

Adolescent↗
PubMed1991

Bladder deformities in patients with neurogenic bladder dysfunction.

231 patients with neurogenic bladder dysfunction were evaluated for bladder deformities. Bladder deformity implies bladder trabeculation and deformity of bladder shape such as pine tree shape. Bladder deformity was judged radiographically at maximum cystometric capacity and classified into grade 0 (none), grade I (mild), grade II (moderate) and grade III (severe). Upper urinary tract deterioration (hydronephrosis and/or reflux) was found in 2% of grade 0, 8% of grade I, 52% of grade II and 62% of grade III. I suggested that bladder deformity was one of the risk factors for upper tract deterioration. High grade deformity (grade II and III) was found more frequently in traumatic spinal cord injury and spinal dysraphism than brain disease. Most patients with low compliance bladder had high grade bladder deformity. The management program including clean intermittent catheterization was effective in preventing bladder deformities.

Humans↗
PubMed2004

Bladder epithelium is abnormal in patients with neurogenic bladder due to myelomeningocele.

OBJECTIVE: To describe the urothelium of the neurogenic bladder in patients with myelomeningocele on clean intermittent catheterization. SETTING: Outpatient practice. METHODS: Samples of bladder wall obtained from two groups of patients were examined for urothelium. The first group included 12 children and young adults with myelomeningocele and neurogenic bladder on intermittent catheterization for bladder emptying. The second group included eight children with vesicoureteral reflux and non-neurogenic bladder. Nine patients from the first group and four patients from the second group had urothelium. A contiguous section of each of the 13 samples with urothelium was stained for uroplakin expression, a marker of superficial bladder urothelium by immunohistochemistry. RESULTS: Samples from children with reflux revealed normal bladder epithelium and a uniform layer of umbrella cells (95% CI: 0-60%). In contrast, the epithelium from all patients with myelomeningocele was abnormal (95% CI: 66-100%). Epithelium from five patients (four children, one adult) revealed chronic inflammation. Three patients (two children, one adult) had squamous metaplasia. The apical surface of the epithelium in all patients with chronic inflammation had some reactivity with anti-uroplakin antibody, but the cells staining positive for uroplakin were scattered along the lumenal surface of the epithelium. The apical surface of patients with squamous metaplasia was negative for uroplakin. CONCLUSION: The urothelium of the neurogenic bladder in young patients with myelomeningocele is abnormal, with loss of uroplakin expression and altered urothelial proliferation.

Adult↗
PubMed1979

Transurethral electroincision of bladder neck in female patients with neurogenic bladder.

Transurethral electroincision of the bladder neck in female patients with neurogenic bladders has not been widely reported. We have performed this operation on 21 patients who have failed to achieve balanced bladder function through other treatment modalities and who have presented with recurrent urinary tract infections, high postvoid residual urine, and evidence of upper urinary tract deterioration. Eighty-five per cent of female patients treated in this fashion have demonstrated significant improvement in bladder emptying. The rate of complication has been low, and no cases of persistent incontinence have occurred. We recommend this operation in difficult cases of neurogenic bladder in females.

Electrosurgery↗
PubMed1999

Nitric oxide synthase expression in neurogenic bladder disease: a pilot study.

Neurogenic bladders are susceptible to bladder cancer development, especially in the case of chronic indwelling catheters. The classic carcinogenesis theory involves the formation of carcinogenic nitrosamines by bacteria due to chronic infection. We designed a pilot study to evaluate the expression of the of Nitric Oxide Synthase (NOS) isoforms in bladder tissue to study the role of the endogenous formation of NO (Nitric Oxide) in neurogenic bladders. Immunohistochemistry was performed on bladder biopsies from neurogenic, normal, and obstructed bladders. The neurogenic bladder had a higher expression of endothelial NOS (eNOS), but especially of neuronal NOS (nNOS). Besides, this extra-neuronal expression of nNOS by urothelium and interstitial cells was observed. This study proves the important role of endogenous formation of NO by suburothelial nerves but also by urothelium and interstitial cells. This overexpression could possibly be a factor in the higher incidence of bladder cancer in neurogenic bladders. On the other hand, it shows the plasticity of the NO pathways in these cases and raises important research questions concerning the physiological role of these changes.

Biopsy↗
PubMed1990

Enveloping the bladder with displacement of flap of the rectus abdominis muscle for the treatment of neurogenic bladder.

Neurogenic bladder is a frequent occurrence. A new surgical technique has been designed and was used successfully in 18 patients with ideal results. The key point of the operation is to turn over a flap of rectus abdominis muscle to envelop the bladder. Contraction of the muscle flap and the abdominal muscles would enhance voiding ability. In the meantime, the bladder is displaced forward and the resultant change in the bladder-posterior urethral angle also favors voiding. Since the bladder is near the anterior abdominal wall manual compression during voiding is made easier. All of these advantages greatly facilitate voiding.

Abdominal Muscles↗