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Neurogenic bladder: urodynamic and surgical aspects.

Children with spina bifida often have vesico-urethral dysfunction manifesting either as upper urinary tract deterioration or voiding dysfunction, chiefly incontinence. Surgery of the back and presence of or increase in hydrocephalus may contribute to neuro-urologic worsening; secondary cord tethering and syrinx or hydromyelia may be additional factors coming into play later in life. Urodynamic assessment using simple modalities like uroflowmetry, external sphincter EMG, residual urine volume and cystometry provide data useful to classify patients according to detrusor and sphincter activity. Besides diagnosis, urodynamic studies are useful in guiding therapy of children with vesico-urethral dysfunction, and for their follow-up to detect sub-clinical deterioration. They also help to prognosticate risk of upper tract deterioration and the possible success of measures to contain incontinence. Urodynamic data in thirty one patients with spinal dysraphism who presented to us with urologic symptoms were analysed. Twenty-three children had hyper-reflexic bladders while in the other 8 the bladder was areflexic. 13 children showed upper tract dilatation. The leak point volume was significantly lower in this group of patients compared to those who did not show upper tract dilatation. Our results are comparable to earlier similar studies.

Adolescent↗
PubMed1975

[Late effects of neurogenic bladder dysfunctions in paraplegics].

The experience is based upon the care of paraplegic patients admitted to the Rehabilitation Centre Tobelbad, near Graz. Pathological changes in the urinary tract are reported as late effects in bladder dysfunctions of paraplegics. The study reviews the late complications of urethra and bladder and outlines the effects of chronic urinary infection, where particular attention is paid to the vesicoureteric reflux. Finally, the problem of urinary stones in paraplegic patients is discussed.

Adult↗
PubMed2000

[A case of neurogenic bladder due to neuro-Behçet disease].

Behçet disease is a systemic vasculitis of unknown cause with variable clinical features. The central nervous system may also be involved in about 10% of the patients with Behçet disease. Half of them show marked central nervous system symptoms and are diagnosed as neuro-Behçet disease. Voiding symptom is seen in about 5% of the patients with neuro-Behçet disease. We report a case of neuropathic vesico-urethral dysfunction in a 39-year-old man with neuro-Behçet disease. Its radiological and urodynamic features and treatment are also presented with some discussion.

Adult↗
PubMed1975

Urinary manometry in patients with spinal cord injury: neurourological considerations in the rehabilitation of acute and chronic neurogenic bladder.

Recordings of pressure within the bladder, urethra, rectum, and external anal sphincter with image intensification and videotaping were carried out in spinal cord injury patients with complete and incomplete lesions, during spinal shock and in the chronic stage. The behavior of the external urethral sphincter and the somatic and visceral motor reflexes of the sacral segments were studied, during and after spinal shock. During spinal shock the majority of patients retained sacral somatomotor activity, in the absence of visceromotor activity, and resistance values at the external urethral sphincter remained high. Vascular oscillations were recorded in the membranous urethra. The highest resistance found in the membranous urethra was at the distal part of the external sphincter.

Acute Disease↗
PubMed2001

[Neurogenic bladder disturbances].

Knowledge of the neurophysiology of bladder control is growing, as better diagnostic methods are developed and because clinical interest in the field is greater and treatments are better. It is problematic that the symptoms are very few and do not provide much information about the lesions in the nervous system. We describe the bladder symptoms in most neurological diseases, and the neurophysiology of normal voiding is described. A strategy for handling neurological bladder symptoms is outlined.

Adult↗
PubMed2002

[Sacral deafferentation and neurostimulation of anterior spinal roots in the treatment of neurogenic bladder in patients with complete transverse spinal lesions--initial clinical experience].

Of those patients who survived the first years after traumatic severing of the spinal cord 85% die from urological complications, their life span being significantly reduced unless they are adequately treated. Sacral deafferentation and electrostimulation of the urinary bladder is in recent years one of the most effective therapeutic methods of neuropathic urinary bladder caused by suprasacral transverse spinal lesions: rhizotomy permanently increases the compliance of the bladder, eliminates hyperreflexion of the detrusor and detrusor-sphincteric dyssynergy--the main causes of nephropathy and urinary incontinence; implantation of a stimulator of the anterior spinal roots enables the patient to control micturition, possibly also defaecation and erection. In countries of the former eastern European bloc the method was not used so far. From January to September 2001 in the Faculty Hospital Brno six patients were operated with complete suprasacral spinal lesions caused by injuries of the spine (from C4 to Th9). All patients recovered without complications. In five patients complete continence was restored, in all six hyperreflexia of the detrusor disappeared completely, four patients use from the second week a neurostimulator for micturition whereby the micturition pressure does not exceed physiological values and the post-micturition residue is negligible. One of the two patients where the response of the bladder to stimulation disappeared during the first week started to use the stimulator again during the 7th month after surgery. Another patient waits now for 5 months for complete regeneration of motor pathways and urinates using intermittent catheterization. Four patients use from the very beginning a neurostimulator for defaecation and one for assisted defaecation. Four patients evaluate the result of surgery as excellent, one as good and he expects further improvement from the effect of stimulation, he objects to the stress incontinence of urine. One patient appreciates the restored urinary continence, but awaits the restored effect of stimulation and therefore is not yet satisfied with the operation.

Adult↗