Diagnosis of neurogenic bladder disease

The condition of the bladder is assessed by the number of spontaneous urinations per day with normal drinking and temperature conditions. Deviations from the physiological rhythm of spontaneous urinations are the most common symptoms of neurogenic bladder.

To determine the type of neurogenic bladder, it is necessary to examine the rhythm and volume of urination and conduct a functional study of the bladder.

The number of urinations more than 8 times a day determines the hyperreflexive type of urination, urination 2-3 times a day - the hyporeflexive type.

The evaluation of the urodynamic function of the lower urinary tract is based on uroflowmetry, retrograde cystometry, urethral profilometry, measurement of intravesical pressure during natural filling of the bladder, electromyography of the anal sphincter and pelvic floor muscles, and pharmacocystometry.

Uroflowmetry is performed using a device that records the volume and speed of urination. Rapid urination is a sign of hyperreflexia, a flattened curve indicates an increase in urethral resistance, intermittent urination is observed with vesicosphincteric dyssynergia.

Profilometry of the vesicoureteral segment shows the profile of pressure changes at the end of the catheter during its uniform removal from the urethra and provides an idea of organic or functional disorders in the lower urinary tract.

Pharmacocystometry allows an objective assessment of the bladder's response to certain medications. Electromyography of the external anal sphincter is used for an indirect assessment of the bladder sphincter function.

When performing an ultrasound of the bladder, uneven contours, an increase or decrease in its size, and incomplete emptying of the bladder are visible. Cystograms show uneven contours, a change in the shape of the bladder, and a sagging neck. Detrusor-urethral dyssynergia is diagnosed using uroflowmetry. On X-rays of the spine, non-closure of the lumbar vertebral arches is diagnosed in approximately 13% of cases.

Standards for daily rhythm and volume of urination in children

Indicator	Girls			Boys
	4-7 years	8-11 years	12-14 years old	4-7 years	8-11 years	12-14 years old
Number of urinations per day	6-7	5-6	4-6	5-7	5-6	4-5
Bladder capacity, ml:
Minimum	68	50	115	63	46	140
Maximum	161	235	270	135	272	325
Average	130	155	197	107	140	190

Despite the scanty symptoms of the initial stage of neurogenic bladder dysfunction, its consequences are quite severe, and over time they are less amenable to therapeutic treatment. Therefore, when the first signs of the disease are detected, it is necessary to begin treatment aimed at correcting the consequences of hypoxia, preventing urinary tract infection and normalizing bladder function.

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