How is neurogenic bladder treated?

Treatment of 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 neurogenic bladder, a protective regime is recommended with the elimination of psychotraumatic situations, with full sleep, refusal of emotional games before bedtime, and walks in the fresh air.

The prescription of drugs provides for a certain influence on the pathogenesis of the neurogenic bladder, its individual links with obtaining a positive clinical effect in a certain percentage of cases. This concerns the restoration of the detrusor-sphincter relationship, the reservoir function of the bladder and controlled urination. Thus, the basis of drug correction of the neurogenic bladder are the effects of various groups of pharmaceuticals: firstly, on the function of the bladder (intravesical hypertension in the accumulation phase), i.e. on detrusor maladaptation; secondly, on the shape of the neurogenic bladder (hyperreflexive or hyporeflexive). Along with treatment directly aimed at improving the functional state of the bladder, measures are taken to normalize the central nervous system. In cases of vegetative dystonia - drugs of sympathotropic or parasympathotropic action depending on the nature of the dysfunction. The use of pharmacotherapy alone is usually not enough. In case of neurogenic bladder, physiotherapeutic treatment is widely used (electrical stimulation, ultrasound, electrosleep, regional hyperthermia of the bladder, electrophoresis of drugs).

Recommended treatment complex

Neurogenic dysfunction of the bladder of the hyporeflexive type:

1. Forced urination regime (every 2-3 hours).
2. Baths with sea salt.
3. A course of adaptogens (ginseng, eleutherococcus, magnolia vine, zamaniha, rosea rhodiola, 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 for a month.
5. .Physiotherapy:
   • electrophoresis with proserin, calcium chloride;
   • ultrasound of the bladder area;
   • stimulation of the urinary bladder (SMT). In further treatment, anticholinesterase agents are used: ubretide (distigmine bromide) inhibiting acetylcholinesterase (prescribed 1/2 tablet (0.25 mg) once every 2-3 days on an empty stomach); aceclidine (cholinomimetic) (administered 0.4-1.0 ml of a 0.2% solution subcutaneously 2 times a day every 12 hours simultaneously with cytochrome C and riboflavin for 12-14 days). A repeated course of treatment is carried out after 1.5 months. Proserin (electrophoresis or orally) at a dose of 1 mg / year of life. Galantamine 1% solution at a dose of no more than 10 mg / kg per day.

Neurogenic dysfunction of the bladder of the hyperreflexive type.

1. Preparations of valerian, peony root, motherwort.
2. Belladonna preparations (belloid, bellataminal).
3. Pantogam orally 0.025 mg 4 times a day for 2-3 months.
4. Picamilon 5 mg/kg per day for 1 month.
5. Physiotherapy:
   • electrophoresis of atropine, papaverine on the bladder area;
   • magnetic therapy;
   • ultrasound of the bladder area;
   • electrical stimulation of the bladder using a relaxing technique;

If treatment is ineffective, anticholinergics are used (one of the drugs is prescribed). For prognostic assessment of the effectiveness of drugs in this group, an atropine test is used, the positive results of which (improvement of urodynamic parameters 30-40 minutes after subcutaneous administration of atropine) are indications for prescribing anticholinergics. Atropine - 0.05-0.5 mg 1 or 2 times a day. Driptan (oxybutynin) for children over 5 years old, 1 tablet (5 mg) 2 times a day (3 times with the last dose before bedtime in case of nocturnal enuresis). Melipramine - 0.02-0.03 g once at night or 0.01-0.025 g at 4 and 8 p.m. The therapeutic dose is achieved gradually, starting with 0.01 g. In addition to the anticholinergic effect, it has myotropic antispasmodic and antidepressant activity.

In recent years, desmopressin, a synthetic analogue of vasopressin, a natural antidiuretic hormone of the neurohypophysis, has been used to treat neurogenic bladder accompanied by nocturnal enuresis. Its use is only possible in children over 5 years of age. The initial dose is 0.1 mg once (at night) with subsequent gradual increase to 0.4 mg. The course of treatment is from 6 weeks to 3 months.

In the development of infectious and inflammatory diseases of the urinary system against the background of this condition, in addition to the main course of antibiotics and uroseptics, it is necessary to additionally take uroseptics in 1/3 of the daily dose once at night for 2 months.

In the presence of neurogenic dysfunction of the bladder, quarterly monitoring of urine tests and, in the presence of intercurrent diseases, monitoring of the rhythm of urination, ultrasound examination of the kidneys and bladder once every 9-12 months are necessary.

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