Neurogenic bladder
Last reviewed: 23.04.2024
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[Epidemiology
Disorders of the act of urination due to a neurogenic bladder are often found in the clinical practice of neurologists, urologists, neurosurgeons and other physicians. It is known that a violation of the act of urination is found in 38-70% of patients with Parkinson's disease. In 50-90% of patients with multiple sclerosis, as well as in all patients with Shia-Dryger syndrome. It is also found in 6-18% of patients with intervertebral disc diseases, in 50% with spina bifida and almost in 100% of patients with spine injuries.
These data indicate a high prevalence of neurogenic bladder in neurological patients. Absence or inadequate treatment of neurogenic disorders of the act of urination often leads to chronic renal failure and even to the death of the patient. It is known that one of the most common causes of death in neurological patients (after respiratory complications) is azotemic intoxication and purulent-inflammatory diseases of the upper urinary tract and lower urinary tract.
Symptoms of the a neurogenic bladder
The neurogenic bladder has symptoms, which are mainly represented by characteristic signs of accumulation: urgent (imperative) and frequent urination during the day and night, as well as urge incontinence. These symptoms are characteristic of neurogenic detrusor hyperactivity.
Symptoms of emptying the bladder include urinating with a thin sluggish stream, the need for abdominal pressure during urination, intermittent urination, a feeling of incomplete emptying of the bladder. They occur when the detrusor contractile activity decreases and there is no adequate relaxation of the transverse striatal urethral sphincter.
Forms
Any lesions of the nervous system between the cerebral cortex and the bladder with sphincters can cause a disruption of the function of the lower urinary tract. In this case, the type of violation largely depends on the level and length of the lesion of the nervous system. The International Society for Urine Retention recommends the use of the functional classification of neurogenic dysfunction of the lower urinary tract, proposed by Madersbacher in 2002.
In this classification, the violation of the act of urination is considered from the point of view of the violation of the function of filling or emptying the bladder, taking into account the behavior of its sphincters, and the characteristics of the condition of the bladder and the striated sphincter of the urethra are given depending on the level of lesion.
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Treatment of the a neurogenic bladder
A neurogenic bladder is treated to achieve the preservation of kidney function, to create conditions for adequate emptying of the bladder or to retain urine, and to improve the quality of life.
In each case, an individual approach is important to determine the tactics of treatment. The choice of method of treatment depends on the type of violation of the function of the lower urinary tract, taking into account the function of detrusor and sphincters of the bladder.
Violation of urine accumulation in the bladder due to neurological diseases and injuries is expressed in neurogenic detrusor hyperactivity (one of the forms of a hyperactive bladder).