Neurogenic Bladder

Neurogenic Bladder: Medical History

Medical history (history of illness) represents an important component in the diagnosis of neurogenic bladder. Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). Have you noticed any changes in urination? Straining to urinate Dysuria – difficult (painful) urination. Frequent urination Urination disorders Urinary incontinence – bladder weakness Urinary interruptions Urinary retention – … Neurogenic Bladder: Medical History

Neurogenic Bladder: Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Malformations such as: Spina bifida – spinal cleft formation due to incomplete vertebral arch closure. Spinal dysraphism (group of congenital malformations due to disturbed closure of the neural tube in the skull, spine and spinal cord), overt – myelomeningocele (meninges and spinal cord bulge out through the vertebral … Neurogenic Bladder: Or something else? Differential Diagnosis

Neurogenic Bladder: Complications

The following are the major conditions or complications that may be contributed to by neurogenic bladder: Symptoms and abnormal clinical and laboratory findings not classified elsewhere (R00-R99). Dysuria (painful urination). Urinary incontinence (bladder weakness) Ischuria (urinary retention; inability to urinate despite a full bladder). Nocturia (nocturnal urination). Pollakisuria (frequent urination) Genitourinary system (kidneys, urinary tract … Neurogenic Bladder: Complications

Neurogenic Bladder: Classification

The following forms of neurogenic dysfunction of the urinary bladder can be distinguished (ICS – International Continence Society classification): Detrusor activity (urinary bladder muscle) Normal Hyperreflexia Hyporeflexia Sphincer externus (external sphincter). Normal Hyperreflexia Hyporeflexia Sensitivity Normal Hypersensitivity Hyposensitivity This results in a variety of combinations of urinary bladder dysfunction.

Neurogenic Bladder: Therapy

Patients with neurogenic bladder dysfunction require long-term monitoring to avoid complications (see Consequential Diseases). General Measures If bladder emptying is not possible to a sufficient degree, intermittent one-time catheterization or suprapubic indwelling catheterization must be performed. Detrusor overactivity (engl. detrusor overactivity; consequence of damage to the nervous system due to diseases, accidents or congenital malformations; … Neurogenic Bladder: Therapy

Neurogenic Bladder: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes [in children: e.g., evidence of dysraphic disorders, such as dimples, lipomas, atypical hairiness, and asymmetric gluteal folds?] External genital and anal region [inflammatory changes?] Auscultation … Neurogenic Bladder: Examination

Neurogenic Bladder: Test and Diagnosis

1st order laboratory parameters – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Urine status (rapid test for: nitrite, protein, hemoglobin, erythrocytes, leukocytes) incl. sediment, if necessary urine culture (pathogen detection and resistogram, that is, testing of suitable antibiotics for sensitivity / resistance) (midstream or better … Neurogenic Bladder: Test and Diagnosis

Neurogenic Bladder: Drug Therapy

Therapy goals Improvement of the continent situation Improvement of the quality of life Restoration of the function of the lower urinary tract (which is usually not possible or only partially possible). Protection of the upper urinary tract Therapy recommendations The following therapy recommendation depending on the particular disorder: For underlying increased bladder outlet resistance: alpha … Neurogenic Bladder: Drug Therapy

Neurogenic Bladder: Diagnostic Tests

Obligatory medical device diagnostics. Renal ultrasonography (kidney ultrasound)/sonography (ultrasonography) of the urinary tract as a basic orienting examination [anatomic changes of the urinary tract? (e.g., double kidney, bladder diverticulum), residual urine volume?]Note: Residual urine measurement (sonographic or by single-use catheterization) is recommended as a screening method. Urodynamics (bladder pressure measurement) with pelvic floor electromyography (EMG) … Neurogenic Bladder: Diagnostic Tests

Neurogenic Bladder: Surgical Therapy

If drug therapy measures are unsuccessful, the following surgical measures are used: Unmanageable detrusor hypertrophy (trabeculation and pseudodiverticulum formation of the bladder): Urinary bladder augmentation (bladder enlargement) with small bowel or an incontinent (ileal conduit)/continent (catheterizable reservoir) drainage system Dorsal rhizotomy – surgical transection of the sensory nerve roots in the region of the lower … Neurogenic Bladder: Surgical Therapy

Neurogenic Bladder: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate neurogenic bladder: Leading symptoms Straining to urinate Dysuria (painful urination) Pollakisuria (frequent urination) Urination disorders Urinary incontinence Urinary interruptions Frequent urination Ischuria (urinary retention; inability to urinate despite a full bladder). Nocturia (nocturnal urination). Very rare urinary bladder emptying with large urine volumes. Delayed urination Detrusor overactivity (engl. … Neurogenic Bladder: Symptoms, Complaints, Signs

Neurogenic Bladder: Causes

Pathogenesis (development of disease) In terms of pathogenesis, the following forms of neurogenic dysfunction of the urinary bladder can be distinguished (ICS – International Continence Society classification). Detrusor activity (urinary bladder muscle). Normal Hyperreflexia Hyporeflexia Sphincer externus (external sphincter). Normal Hyperreflexia Hyporeflexia Sensitivity Normal Hypersensitivity Hyposensitivity This results in a variety of combinations of urinary … Neurogenic Bladder: Causes