How is the neurogenic bladder treated?

Treatment of a neurogenic bladder is a complex task that requires joint efforts of nephrologists, urologists and neuropathologists with a complex of differentiated corrective measures. For patients with a neurogenic bladder, a protective regime is recommended with the elimination of psychotraumatic situations, with a full sleep, the abandonment of emotional games before a night's sleep, and walking in the fresh air.

The purpose of medicinal products is to exert a certain influence on the pathogenesis of the neurogenic bladder, its individual links, with a positive clinical effect in a certain percentage of cases. This relates to the restoration of detrusor-sphincter relations, reservoir function of the bladder and controlled urination. Thus, at the heart of the drug correction of the neurogenic bladder are the effects of the influence of different groups of pharmaceuticals: first, on the function of the bladder (intravesical hypertension in the accumulation phase), i.e. On disadaptation detrusora; secondly, on the form of the neurogenic bladder (hyperreflective or hyporeflective). Along with treatment aimed directly at improving the functional state of the bladder, measures are taken to normalize the CNS. In cases of vegetative dystonia, drugs are sympatotropic or parasympatotropic, depending on the nature of the dysfunction. The use of one pharmacotherapy is usually not enough. In the neurogenic bladder, physiotherapy (electrostimulation, ultrasound, electrosleep, regional bladder hyperthermia, electrophoresis of drugs) is widely used.

Recommended therapeutic complex

Neurogenic bladder dysfunction according to the hyporeflective type:

1. Mode of forced urination (after 2-3 hours).
2. Baths with sea salt.
3. The course of adaptogens (ginseng, eleutherococcus, lemongrass, zamanicha, rhodiola rosea, golden root, 2 drops of tincture per year of life in the first half of the day).
4. Glycine orally 10 mg / kg per day. During months.
5. .Physiotherapy:
   • electrophoresis with proserin, calcium chloride;
   • ultrasound on the urinary bladder;
   • stimulation of the bladder (CMT). With further treatment, anticholinesterase drugs are used: ubretid (distigmine bromide) inhibiting acetylcholinesterase (prescribed by 1/2 tablets (0.25 mg) 1 time in 2-3 days on an empty stomach); acetylidine (cholinomimetic) (0.4-1.0 ml of 0.2% solution is injected subcutaneously 2 times a day 12 hours simultaneously with cytochrome C and riboflavin for 12-14 days). The repeated course of treatment is carried out after 1.5 months. Prozerin (electrophoresis or oral) at a dose of 1 mg / year of life. Galantamine 1% solution in a dose of not more than 10 mg / kg per day.

Neurobrain dysfunction of the bladder by hyperreflex type.

1. Valerian preparations, peony roots, motherwort.
2. Preparations of belladonna (belloid, bellataminal).
3. Pantogam orally to 0,025 mg 4 times a day for 2-3 months.
4. Pikamilon 5 mg / kg per day for 1 month.
5. Physiotherapy:
   • electrophoresis of atropine, papaverine on the urinary bladder;
   • magnetotherapy;
   • ultrasound on the urinary bladder;
   • electrostimulation of the bladder by a relaxing technique;

If the treatment measures are ineffective, anticholinesergics are used (one of the drugs is prescribed). For the prognostic evaluation of the efficacy of this group, an atropine sample is used, the positive results of which (improvement of urodynamics after 30-40 minutes after subcutaneous administration of atropine) are indications for the appointment of anticholinergics. Atropine - at 0,05-0,5 mg 1 or 2 times a day. Driptan (oxybutynin) in children older than 5 years of 1 tab. (5 mg) 2 times a day (3 times with the last dose before bedtime with nocturnal enuresis). Melipramine - 0,02-0,03 g once a night or 0,01-0,025 g at 16 and 20 hours. The therapeutic dose is achieved gradually, starting at 0.01 g. In addition to anticholinergic action, it has myotropic antispasmodic and antidepressant activity.

In recent years, for the treatment of a neurogenic bladder, accompanied by nocturnal enuresis, desmopressin is used - a synthetic analogue of vasopressin, a natural antidiuretic hormone neurohypophysis. Its use is only possible in children who have reached the age of five. The initial dose is 0.1 mg once (at night) followed by a gradual increase to 0.4 mg. The course of treatment is from 6 weeks to 3 months.

With the development of infectious and inflammatory diseases of the urinary system in the background of this condition, in addition to the main course of antibiotics and uroseptics, an additional intake of uroseptics is necessary in 1/3 of the daily dose once a night for 2 months.

In the presence of neurogenic dysfunction of the urinary bladder, a quarterly control of urine tests and against intercurrent diseases is necessary, control of the rhythm of urination, ultrasound examination of the kidneys and the bladder once every 9-12 months.

[1], [2], [3]