The wrinkled bladder
The wrinkled bladder — the functional or anatomic reduction of a cavity of a mochevik which arose against the background of other diseases. It is shown by a pollakiuriya, nikturiy, is more rare — weight and pain over a pubis which intensity decreases after an urination. It is diagnosed by means of a sonografiya of a bladder, a retrograde tsistografiya, urodinamichesky researches. For correction of frustration treatment M-holinolitikami, a medicamentous and surgical denervation of a detruzor, hydrodilatation, a cistop eraser after a partial or radical tsistektomiya are shown.
The wrinkled bladder
(Microcisyew) wrinkled usually complicates the course of other diseases and pathological states leading to violation of an innervation of a bladder, inflammatory processes in mucous and muscular layers of its wall. For children and patients of young age diagnose neurogenetic option of frustration more often. In the senior age contingents organic cicatricial and sclerous wrinkling of body prevails. Relevance of timely detection of pathology is caused by essential deterioration of life of patients and high risk of secondary dysfunction of kidneys.
The reasons of the wrinkled bladder
Reduction of functional and anatomic capacity of a mochevik can be caused both by violation of an innervation of a muscular layer, and organic damages of a wall. The neurogenetic option of a disease caused by a bladder hyperactivity is observed at 15,6%-16% of male patients and at 16,9-17,4% of sick women. The temporary or constant dysfunction of spinal or kranialny parts of the nervous system leading to a hyper tone of mochepuzyrny muscle fibers is its cornerstone. Are the main organic reasons for frustration:
- Bacterial and parasitic inflammation. More than in 60% of cases wrinkling of a bladder happens at defeat of urinary bodies a tuberculosis mikobakteriya. At the same time cicatricial and sclerous deformation of body is often aggravated with its hyper reflection owing to constant irritation of the receptor device a pathogenic microorganism. Wrinkled also comes to light at patients with shistosomozy (bilgartsiozy).
- Noninfectious cystitis. Interstitsialny cystitis of which, most likely, autoimmune and allergic processes are the cornerstone is a common cause of reduction of volume of a bladder. Besides, post-inflammatory deformation of a mochepuzyrny wall is observed as a result of the postponed beam cystitis complicating radiotheraphy of malignant new growths of pelvic bodies (a prostate cancer, a uterus neck, etc.).
- Long artificial removal of urine. At a kateterization and a tsistostomiya of a bladder urination happens spontaneously without detruzor tension. As urine in body actually does not collect, its volume naturally decreases. Shortening, a hypotrophy, and in extreme cases and an atrophy of the muscle fibers, long time which are not experiencing functional strain become an additional prerequisite to wrinkling.
The mechanism of formation of the wrinkled bladder depends on the reasons which provoked a disease. The pathogenesis of a functional microcisyew is caused by a resistant spasm of gladkomyshechny fibers against the background of a pathological efferent impulsation from an affected area back or a brain. At an organic form of frustration inflammatory defeat of an urovezikalny wall comes to the end with its fibrosis, cicatricial deformation with an atrophy of muscle fibers, their replacement with connecting fabric. The fibrous changed detruzor has smaller elasticity that leads to anatomic reduction of volume of a mochevik.
Symptoms of the wrinkled bladder
The disease is shown by the insuperable desires to an urination arising till 18-23 once a day including from 6 times and at more night. Reduction of volume of the emitted urine in every portion is noted. A part of patients shows complaints to heavy feeling or squeezing in nadlobokovy area. In rare instances there is a morbidity in the bottom of a stomach which intensity decreases a little after an urine otkhozhdeniye. Development of neurotic symptomatology with feeling of constant fatigue, bystry fatigue, irritability, tearfulness, decrease in mood, uneasiness is possible.
At the long course of a disease, development of a sclerosis in the field of a mochepuzyrny triangle with a stenosis of mouths of mochetochnik the natural passage of urine is broken. At 75-77% of patients with wrinkled mocheviky the stagnant processes caused by the organic reasons come to the end with development of a gidroureteronefroz, decrease in functionality of kidneys, increase of symptoms of a chronic renal failure, sedimentation of salts in a cup lokhanochnoy to system (an urolithic disease). Emergence of a puzyrno-mochetochnikovy reflux promotes spread of an infection on the departments of an urinary system located above, to development of chronic pyelonephritis.
Diagnostic search at patients with suspicion on the wrinkled bladder is directed to assessment of capacity of body, a functional solvency of a detruzor, definition of option of a disease, identification of the reasons which led to decrease in anatomic or functional capacity. The patient appoint the comprehensive tool examination including such recommended diagnostics methods as:
- Ultrasonography of a bladder. Carrying out an ekhografiya can be complicated because of need of performance of a research on the filled mochevik therefore in some cases preferable are transvaginal, transrectal, transurethral methods of scanning. The volume of the wrinkled body is significantly reduced. After depletion in it the normal or reduced amount of residual urine is defined.
- Retrograde tsistografiya. Introduction to a cavity of a bladder of X-ray contrast substance allows to estimate more precisely its capacity on the volume of instillirovanny medicine. In a x-ray picture sharp reduction of the sizes of body, possible changes of its form and arrangement are defined, the specific defects of a mucous membrane characteristic of tubercular process, a new growth, stones, inflammation signs come to light.
- Urodinamichesky researches. By means of an urofloumetriya and a tsistometriya of depletion it is possible to find primary or secondary hyper reflection of a detruzor in the absence of obstruction of the lower departments of an urinary system. Tsistometriya of filling reveals decrease in volume of liquid at which there is a desire to an urination. As an additional method the videourodinamichesky research is recommended.
Informative method of identification of the possible reasons of the wrinkled mochevik is the tsistoskopiya allowing to estimate a condition of a mucous membrane, to find signs of sclerous processes, to receive samples of fabrics for the subsequent histologic research of a bioptat. At a part of patients inflammatory changes (a leykotsituriya, a bakteriuriya) decide on a microcisyew in the general analysis of urine, the causative agent of cystitis can be revealed by means of crops of urine on microflora. According to indications for an exception of possible renal pathology carry out ultrasonography of kidneys, excretory urography, a nefrostsintigrafiya, biochemical blood test, a nephrological complex.
At suspicion KT of a skull, MSKT of a backbone, MRT of a brain, lumbar and sacral department of a spine column are recommended for the neurogenetic nature of pathology. Differential diagnostics is carried out between a functional and organic form of frustration, diseases which are capable to provoke development of pathology, and also with endofitny cancer of a bladder. According to the decision of the urologist to the patient appoint consultations of the phthisiatrician, the infectiologist, the parasitologist, the neuropathologist, the neurosurgeon, the oncologist.
Treatment of the wrinkled bladder
The main objectives when maintaining patients with a microcisyew is reduction of frequency of urinations, increase in accumulative ability, elimination of the reasons which caused and supporting a disease. At exact establishment of a factor which provoked frustration appoint the corresponding etiopatogenetichesky treatment. In urology apply the following therapeutic and surgical approaches to knocking over of symptomatology:
- Medicamentous relaxation of a detruzor. Treatment is begun with conservative therapy with blockers M-holinoretseptorov. Having spazmolitichesky effect, medicines of this group reduce a tone of a muscular layer of a bladder at the expense of what the frequency of urinations decreases and the capacity of the wrinkled body increases. The injection of a botulotoksin in a detruzor leading to a reversible atrophy of the nervous terminations can be as an alternative offered. Medicinal therapy is more effective at functional type of frustration.
- Hydrodilatation. The method is widely applied to non-invasive increase in capacity of the wrinkled mochevik by forcing of liquid in it. At adequate holding a procedure there is short-term ischemia of receptors of muscle fibers with reduction of primary and secondary hyperreactivity of a detruzor. During hydrodilatation it is also possible to estimate more precisely bladder wall tensile properties, its reservoir function, the prospects of restoration of capacity of body in the presence of sclerous changes.
- Crossing of nervous fibers. The most often partial denervation of the wrinkled mochevik is carried out during a transurethral detruzorotomiya. Decrease in intensity of a pathological impulsation allows to get rid of imperative desires to an urination and to indirectly increase the accumulative capacity of a mochevik. The method differs in high efficiency and safety. Denervation of a muscular cover by an open or endoscopic circular section of a wall did not find broad application because of insufficient efficiency.
- Plasticity of a bladder. Replacement of a mochepuzyrny wall with fragments of bodies of a GIT is shown at the organic wrinkled mochevik with a high rigidnost of sklerozirovanny fabrics. Less often operation is applied at therapeutic resistant functional frustration. In the absence of complications it is carried out augmentatsionny a cistop eraser with creation of the "patch" increasing the volume of a mochevik. If the disease became complicated ureterogidronefrozy, the partial or radical tsistektomiya from the subsequent enterotsistoplastiky is preferable.
Treatment is supplemented with the physiotherapeutic procedures directed to decrease in hyperreactivity of the wrinkled detruzor: medicinal electrophoresis of holinolitik and spazmolitik, ultrasonic therapy, paraffin applications. Non-drug methods, as well as correction of a way of life with reduction of psychoemotional loadings, render bigger effect at neurogenetic reduction of a bladder. At organic defeat they are less significant though they in general can facilitate symptomatology due to impact on a secondary hyper reflection.
Forecast and prevention
The right choice of a method of the treatment corresponding to the reason and a form of a disease tensile properties of a mochepuzyrny wall allows to compensate frustration, and at the favorable forecast completely to restore the volume of the wrinkled body. Efficiency of conservative holinolitichesky therapy makes 24-39%, and as 47-57% of patients have side effects, now carry out more productive surgical denervation or to a cistop eraser more often.
Prevention of a disease is directed to the prevention of developing of tuberculosis, timely therapy of its pulmonary and extra pulmonary forms, treatment of cystitis of various origin, reduction of terms of artificial removal of urine with the early beginning of trainings of a detruzor. For the prevention of wrinkling after performing radiation therapy of pelvic bodies the bladder needs to be emptied before each session of the ionizing influence, and in his cavity to inject radio protective drugs.