Neurogenic bladder dysfunctionis a violation of the normal activities of the body. Pathology is quite widespread. In urology and pediatric pediatrics, about 10% of all diseases of the urinary system are occupied by this particular ailment. At the same time, the risk of changes in the organs of the secondary type system is increased. Disorder urination due to impaired nervous regulation at the peripheral or central level. Next, consider what constitutes a neurogenic dysfunction of the bladder at a younger age.
General information
Нейрогенный мочевой пузырь у женщин обусловлен severe childbirth, gynecological surgery, as well as chronic pathologies of the pelvic organs. The disease may appear suddenly or progress gradually. Neurogenic bladder in men often occurs on the background of prostate adenoma, as well as after prolonged activity associated with weight lifting. In pathology, a person observes the excretion of urine drop by drop and the inability to keep it in stressful situations. Neurogenic bladder in a child may have a primary form. In this case, hereditary nerve pathologies act as a provoking factor. Disorder of urination at a younger age may be secondary. In this case, the formation of pathology occurs under the influence of exogenous or endogenous factors.
Reflex formation
У ребенка полностью контролируемый зрелый режим urination is formed by a 3-4 year old. The system goes through several stages of development - from a spinal unconditioned reflex to an arbitrary reflex act. Subcortical and cortical brain centers, spinal innervation zones in the lumbosacral spinal cord, as well as peripheral nerve plexuses are involved in the regulation of fluid flow. Neurogenic bladder in a child is accompanied by impaired innervation and reserve-vacuum processes. Pathology can trigger a number of serious diseases. These include, in particular, chronic renal insufficiency, pyelonephritis, cystitis, hydronephrosis, megaureter, vesicoureteral reflux.
The provoking factors
Neurogenic bladder dysfunctiondevelops as a result of various neurological disorders. They lead to a decrease in the coordination of activity of the external sphincter or detrusor during accumulation and release of fluid. Neurogenic bladder in a child may develop against the background of organic CNS lesions. They, in turn, can be triggered by injuries, inflammatory-degenerative and neoplastic pathologies of the spinal column, congenital malformations, diseases of the spinal cord and brain. Spinal hernias, birth injuries, dysgenesis and agenesis of the coccyx and sacrum, cerebral palsy and others are among the ills against which a neurogenic bladder develops in a child. They lead to complete or partial dissociation of the spinal and supraspinal nerve centers and organ. Most often, the pathology is found in girls. This is due to increased estrogen saturation, which increases the sensitivity of the detrusor receptors.
Classification
В соответствии с изменениями пузырного рефлекса, There are several types of pathology. In the hyperreflex bladder, there is a spastic condition in the stage of fluid accumulation. Hyporeflex type of pathology is accompanied by detrusor hypotension in the release phase. It is characterized by the appearance of a reflex to urinate with a functional volume of the bladder, significantly larger than normal in age. With hyperreflexion, the appearance of the reaction is noted long before the accumulation of the prescribed amount of fluid. Areflex type of pathology is considered the most severe. It is accompanied by the impossibility of self-reduction of the full and full bladder, as well as the involuntary act of emptying. Pathology is also classified according to the degree of adaptability of the detrusor to the increasing volume of fluid. So, the neurogenic bladder can be unadapted (unbraked) and adapted. There are also several forms of the disease. In particular, when a patient has a mild form, the bladder becomes empty spontaneously under stressful situations. Symptoms of severe form are the development of Hinman's syndromes - detruzorno-sphincter dissenergy, Ochoa - uro-facial pathology. In moderate forms, there is instability in the activity of the body.
The clinical picture of hyperreflexia
Что происходит, когда нестабильно работает bladder? Symptoms of pathology manifest in violations of the act of emptying. Their severity and frequency of occurrence are determined in accordance with the degree of nervous damage. Neurogenic hyperactivity usually prevails in young children. In this case, there are frequent emptyings (up to eight times a day) in small volumes, imperative urges, enuresis, incontinence. Postural neurogenic bladder, the symptoms of which appear when the horizontal position of the body changes to a vertical one, is accompanied by daytime pollakiuria, as well as undisturbed accumulation of urine at night with a normal volume of the morning portion. Stress incontinence is manifested by the loss of a small amount of fluid. Such a phenomenon may occur during exercise. On the background of detrusor-sphincter dissenergy there is an absolute delay or incomplete emptying, as well as miccation (urination) during straining.
Manifestations of hyporeflexia
Against the background of this type of pathology, rareor missing urination when the bladder is full or full. Emptying can also be sluggish, with tension in the wall of the peritoneum. Often there is a feeling of incomplete urine output. This is due to the large volume of residue (up to 400 ml). In some children, paradoxical ischuria is possible, accompanied by uncontrolled release of urine. This is due to the gaping of the external sphincter, which stretches under the pressure of an overcrowded organ. With a lazy bladder, there are rare urinations, combined with incontinence, infections of the tract, and constipation. In advanced stages of the pathology, there is a risk of developing inflammation, impaired blood flow in the kidneys, scarring of the parenchyma and the formation of shrinkage of the secondary kidney, chronic insufficiency and nephrosclerosis.
Diagnostics
At occurrence of urination disordersIt is necessary to conduct a comprehensive survey. It should include such doctors as a pediatrician, psychologist, neurologist, nephrologist, urologist. Diagnosis includes anamnesis. Identifies a family predisposition to the development of pathology, whether there were injuries, diseases of the nervous system and so on. The results of instrumental and laboratory studies are also evaluated. To identify infections and functional renal disorders on the background of the pathology, a biochemical analysis of blood and urine is carried out, a sample according to Nechiporenko, Zemnitsky, and also bacteriological analysis. Urological examination includes ultrasound. The kidneys and the bladder are examined to determine the residual volume. An X-ray diagnostic method is also included in the examination. Perform excretory and review urography, mock cytography. CT and MRI of the renal system, endoscopy, and radioisotope scanning are also performed. Assessment of the condition of the bladder is carried out by tracking the daily volume and rhythm of spontaneous urination at normal temperature and drinking regime. Urodynamic examination of the functional state of the lower parts of the system, uroflowmetry, measurement of internal pressure during natural filling, electromyography, profilometry, cystometry (retrograde) have a high diagnostic significance in identifying the disease. Echo EG, EEG, MRI of the brain, radiography of the spine and skull are also performed if the neurogenic bladder is suspected in children. Komarovsky in one of his articles describes in detail the clinical analysis (OAM).
Therapeutic events
Они назначаются в соответствии с типом, тяжестью disorders related diseases. As a rule, differentiated tactics are used. Many experts prescribe homeopathic medicines. However, there are doctors who do not trust these drugs. For example, Komarovsky does not recommend homeopathic medicines if a neurogenic bladder is detected in children. It should be said that the doctor is generally skeptical of this kind of therapy. However, there are many cases in practice where homeopathy was very effective. Timely diagnostics and correctly chosen tactics of therapy allows you to quickly eliminate the pathology.
Drug effects
Для устранения гипертонуса пациентам назначаются M-holinoblokatory. These include such medicines as "Atropine", "Oxybutynin" (for patients from the age of five). Also shown are tricyclic antidepressants (for example, Melipramine), Ca + antagonists (these include the drugs Nifedipine, and Terodilin), nootropics (among them, Pikamilon and Pantogam). Motherwort and Valerian tinctures are also recommended if a neurogenic bladder is diagnosed in children. Treatment with folk remedies allows you to enhance the effectiveness of primary therapy, as well as with the lowest risk to alleviate the condition, because it has a minimum of side effects. In the presence of nocturnal enuresis, patients from the age of five may be prescribed an analogue of the neurohypophysis antidiuretic steroid - desmopressin. For the prevention of the development of infection, small doses of uroseptics are recommended for patients. These include, in particular, nitrofurans (means "Furagin"), oxyquinolones (preparation "5-NOK"), fluoroquinolones (which is nalidix), medicine "Canephron", immunocorrective effects (medicines Taktivin, Levamisol) .
Additionally
Для облегчения состояния назначается urination schedule in 2-3 hours. Regular catheterization, the use of cholinomimetics, anticholinesterase drugs, adaptogens are also shown. Recommended baths with medicinal sea salt.
Operational methods
When the neurogenic bladder is carried outendoscopic intervention. In particular, transurethral resection of the organ neck, implantation of collagen in the mouth of the urethra, intraurethral and intratrucer infusions of botulinum toxin are performed. Interventions on the nerve ganglia, which are responsible for urination, are also performed. With the help of intestinal cystoplasty, the volume of the bladder is increased.
