Neurogenetic bladder – the bladder dysfunction caused by the congenital or acquired pathology of nervous system. Depending on a condition of a detruzor differentiate hyper - and hyporeflex type of a neurogenetic bladder. The neurogenetic bladder can be shown by a pollakiuriya, an incontience of urine or its pathological delay. Diagnostics of a syndrome consists in full nevrologo-urological inspection (analyses, urography, ultrasonography of kidneys and a bladder, an uroflourometriya, a tsistografiya and a tsistoskopiya, a sfinkterometriya, a X-ray analysis and MRT of a backbone, brain MRT and so forth). Treatment of a neurogenetic bladder can include non-drug and medicinal therapy, a bladder kateterization, surgery.
Neurogenetic bladder - rather widespread state in urology connected with impossibility of implementation of any and reflex accumulation and release of urine because of organic and functional defeat of the nervous centers and ways regulating this process.
Allocate the hyper reflex neurogenetic bladder which is shown in an accumulation phase a detruzor hyperactivity (at nadsegmentarny defeats of nervous system) and hyporeflex - with the reduced activity of a detruzor in an allocation phase (at defeat of the segmentary and peripheral device of regulation of an urination). The neurogenetic bladder can have mistiming of activity of a detruzor and a sphincter of a bladder (an internal and external detruzorno-sfinkterny dyssynergia) in a basis.
Frustration of an urination at a neurogenetic bladder have social aspect as can limit physical and mental activity of the person, create a problem of his social adaptation in society. The neurogenetic bladder often is followed by a miofastsialny syndrome, a syndrome of a pelvic venous kongestiya (venous stagnation). More than in 30% of cases the neurogenetic bladder is followed by development of secondary inflammatory and dystrophic changes from an urinary system: the puzyrno-mochetochnikovy reflux, chronic cystitis, pyelonephritis and an ureterogidronefroz leading to arterial hypertension, nephrosclerosis and a chronic renal failure that can threaten with an early invalidization.
Reasons of a neurogenetic bladder
The failure happening at any stage of difficult multilevel regulation of process of an urination can lead to development of one of numerous clinical options of a neurogenetic bladder.
The most often neurogenetic bladder at adults is tied with injury of a head and spinal cord of traumatic character (at a stroke, a sdavleniye, surgical intervention, spinal fracture), and also with inflammatory and degenerate and tumoral diseases of nervous system - encephalitis, disseminated encephalomyelitis, polyneuropathy (diabetic, vaccine-challenged and toxic), poliradikulonevrity, tuberkulomy, holesteatomy, etc.
The neurogenetic bladder at children can take place at congenital defects of development of TsNS, a backbone and urinary bodies, after the postponed patrimonial trauma. The urine incontience at a neurogenetic bladder can be caused by decrease in tensile properties and capacity of a bladder owing to cystitis or neurologic diseases.
Symptoms of a neurogenetic bladder
The syndrome of a neurogenetic bladder can have continuous, periodic or incidental manifestations, and the variety of its clinical options is defined by distinction of level, character, severity and a stage of defeat of nervous system. Are typical for a hyperactive neurogenetic bladder: pollakiuriya, including nikturiya, imperative desires and incontience of urine. Prevalence of a tone of a detruzor at a hyper reflection of a bladder leads to substantial increase of vnutripuzyrny pressure at small amount of urine that at weakness of sphincters causes imperative desires and the speeded-up urination.
The hyperactive neurogenetic bladder is characterized by a spastic state and depletion at accumulation less than 250 ml of urine; absence or small volume of residual urine, difficulty of any beginning and act of an urination; emergence of vegetative symptoms (perspiration, rise in arterial pressure, strengthening of a spastika) before a miktion in lack of desires to an urination; an opportunity to provoke an urination irritation of area of a hip and over a pubis. At a combination of a neurogenetic bladder to some neurologic violations there can be an uncontrollable rapid allocation of large volume of urine (in the absence of residual) – "the cerebral not slowed down bladder".
Relative prevalence of a tone of sphincters at a detruzorno-sfinkterny dyssynergia is expressed by a full delay of urine, an urination at a natuzhivaniye, availability of residual urine. The hypoactive neurogenetic bladder is shown by decrease or lack of sokratitelny activity and depletion at full and even crowded bubble in an allocation phase. Because of hypotonia of a detruzor there is no increase in the vnutripuzyrny pressure necessary for overcoming resistance of a sphincter that conducts to a full delay or a sluggish urination, a natuzhivaniye during a miktion, to existence big (up to 400 ml) the volume of residual urine and to preservation of feeling of fullness of a bubble.
At the gipotonichny stretched bladder the urine incontience (a paradoxical ishuriya) when at overflow of a bladder there is mechanical stretching of an internal sphincter and uncontrollable release of urine drops or in the small portions outside of is possible. Denervation of a neurogenetic bladder causes development of the expressed trophic violations and complications in the form of the interstitsialny cystitis leading to a sklerozirovaniye and wrinkling of a bladder.
At a neurogenetic bladder in urinary tract the stones breaking urine outflow, provoking development of an infection can be formed. In case of a spasm of a sphincter of a bladder there can be a puzyrno-mochetochnikovy reflux (the return throwing of urine in mochetochnik and kidneys leading to an inflammation). The syndrome of a neurogenetic bladder often is followed by functional neurotic frustration which can become further defining.
Diagnostics of a neurogenetic bladder
For diagnostics of a neurogenetic bladder it is necessary to carry out careful collecting the anamnesis, laboratory and tool inspection. In poll of parents of the child with a neurogenetic bladder find out how childbirth proceeded whether there is a hereditary predisposition to a disease. For an exception of inflammatory diseases of an urinary system make blood test and urine - the general, across Nechiporenko, functional test of Zimnitsky, a biochemical research of urine and blood.
The main methods of tool diagnostics of a neurogenetic bladder are ultrasonography of kidneys and a bladder, a tsistoskopiya, MRT, a radiological research of urinary tract (a usual and miktsionny uretrotsistografiya, excretory urography, the ascending piyelografiya, a radio isotope renografiya), urodinamichesky researches (a tsistometriya, a sfinkterometriya, a profilometriya, an urofloumetriya).
In the absence of diseases from an urinary system conduct neurologic examination for detection of pathology of a head and spinal cord with application of KT and MPT, elektorentsefalografiya, X-ray analysis of a skull and backbone. Also differential diagnostics of a neurogenetic bladder with a prostate hypertrophy, a stressful incontience of urine at elderly people is carried out. At impossibility to establish the reason of this disease speak about a neurogenetic bladder with not clear etiology (idiopathic).
Treatment of a neurogenetic bladder
Therapy of a neurogenetic bladder is carried out in common by the urologist and the neurologist; its plan depends on the established reason, type, degree of expressiveness of dysfunction of a bladder, the accompanying pathology (complications), efficiency of earlier carried out treatment. At a neurogenetic bladder apply non-drug, drug and surgical treatment, since less traumatic and safer medical actions.
The hyperactive neurogenetic bladder will respond to treatment better. Use the medicines which are reducing a tone of muscles of a bladder, intensifying organ blood circulation and eliminating a hypoxia: antikholinergichesky medicines (, , ), tritsiklichesky antidepressants (), antagonists of calcium (nifedipine), alpha (phentolamine, phenoxybenzamine).
Recently quite perspective in treatment of a hyper reflection of a neurogenetic bladder, a detruzorno-sfinkterny dyssynergia and infravezikalny obstruction consider application of injections of a botulotoksin in a wall of a bladder or urethra, vnutripuzyrny introduction of a kapsaitsin and rezinferatoksin. In addition appoint medicines on the basis of amber acid, a L-carnitine, gopantenovy acid, N - nicotinoyl - gamma aminobutirovaya the acid, kofermentny forms of vitamins possessing anti-hypoxemic and antioxidant action.
In parallel apply non-drug methods of treatment of a neurogenetic bladder: physiotherapy exercises (special exercises for pelvic muscles), physical therapy (electrostimulation, laser therapy, hyperbaric oxygenation, a diadinamoterapiya, thermal applications, ultrasound), a bladder training, normalization of the mode of drink and dream, psychotherapy.
The hypoactive neurogenetic bladder gives in to therapy more difficultly. The available developments of stagnation in a bladder create risk of accession of an infection, development of secondary defeats of uric system. In treatment of a neurogenetic bladder with symptoms of hypotonia ensuring regular and full depletion of a bladder is important (by means of compulsory urinations, an external compression (Krede's reception), methods of physical therapy, a training of muscles of a bladder and a pelvic bottom, a periodic or constant kateterization).
As medicamentous therapy of a neurogenetic bladder apply indirect and M-holinomimetiki ( chloride, a distigmin bromide, , ), motility of a bladder, to reduce its effective volume and the amount of residual urine allowing to strengthen. Individually appoint alpha (phenoxybenzamine - at an internal detruzorno-sfinkterny dyssynergia, diazepam and - at an external detruzorno-sfinkterny dyssynergia), alpha ( and - in case of an urine incontience at a tension).
At medicamentous therapy of a neurogenetic bladder control of amount of residual urine and reception of antibacterial medicines (nitrofurans, sulfanylamides), especially are necessary for patients for prevention of uric infections with a puzyrno-mochetochnikovy reflux.
Surgical endoscopic intervention at hypotonia of a neurogenetic bladder consists in a transurethral funneled resection of the neck of a bladder providing further a possibility of depletion of a bubble with weak pressing outside. At a hyper reflex bladder (with spastiky a pelvic bottom and a detruzorno-sfinkterny dyssynergia) carry out a cut of an external sphincter that reduces an urination pressure, and in the subsequent - hyperreactivity of a detruzor, increasing bubble capacity.
Also at a neurogenetic bladder carrying out expeditious increase in a bladder (with use of plasticity of fabrics), elimination of a puzyrno-mochetochnikovy reflux, statement of a tsistostomichesky drainage for depletion of a bladder is possible. Pathogenetic treatment of a syndrome of a neurogenetic bladder allows to reduce risk of damage of urinary bodies and need of surgery in the future.