The various types of neurogenic bladder dysfunction: an update of current therapeutic concepts

医学 电流(流体) 梅德林 神经源性膀胱功能障碍 膀胱疾病 重症监护医学 神经科学 膀胱 泌尿科 政治学 法学 电气工程 生物 工程类
作者
H. Madersbacher
出处
期刊:Spinal Cord [Springer Nature]
卷期号:28 (4): 217-229 被引量:103
标识
DOI:10.1038/sc.1990.28
摘要

Increased experience with treatment strategies developed during the last 10 years in the field of neurourology justifies an update of current therapeutic concepts. Based on a rather simple, but clinically useful, classification of detrusor-sphincter dysfunction the therapeutic concepts now available for four prototypes of detrusor-sphincter dysfunction are discussed. (1)For the combination of a hyperreflexive detrusor with a hyperreflexive (spastic) sphincter, characteristic for the reflex- and the uninhibited neuropathic bladder, detrusor sphincter dyssynergia (DSD) is still the greatest problem, and transurethral sphincterotomy is the method of choice if this situation cannot otherwise be managed. One concept is to convert detrusor hyperreflexia into hyporeflexia by adequate pharmacotherapy, which is nowadays available, and to assist or to accomplish bladder emptying by clean intermittent (self-) catheterisation (CIC) with the advantage of dry intervals in between. Japanese colleagues recommend bladder overdistension during the spinal shock phase to achieve detrusor hyporeflexia, but this procedure is rather decisive at an early stage of the disability, leaving the detrusor no chance for further rehabilitation. Another possibility is rhizotomy of the sacral posterior roots to eliminate detrusor hyperreflexia, and the simultaneous implantation of a sacral anterior root stimulator (Brindley) to achieve electrically induced micturition. From our personal experience with 12 patients this concept is ideal for female patients with unbalanced reflex bladder and otherwise uncontrollable reflex incontinence. (2)The combination of a weak detrusor with a spastic sphincter is a clear indication for CIC, as the bladder is emptied regularly, and due to the spastic sphincter, the patient stays continent as long as controlled fluid intake prohibits overflow incontinence. The implantation of an anterior sacral root stimulator is an alternative approach provided that at least weak reflex detrusor contractions are present. (3)With the combination of an areflexive or hyporeflexive detrusor and a flaccid pelvic floor, passive voiding by abdominal straining or by the Credé manoeuvre is usually recommended, but should be replaced by CIC if this mechanism of bladder emptying creates unphysiological high and dangerous intravesical pressures, or if vesicouretero-renal reflux is present. Neurogenic urinary stress incontinence is usually associated with this type of lesion and can be successfully treated by the implantation of an artificial urinary sphincter (Scott). However in two thirds of the patients with neurogenic bladder dysfunction, additional, usually operative treatment is necessary to meet the criteria for implantation. Moreover, a 30% rate of repair operations must be accepted by patients, but is becoming less frequently required with an improved design of the device. With conventional operations continence can only be achieved in those patients by maximal elevation of the bladder neck thus inducing bladder outflow obstruction requiring consequent CIC, but CIC may be difficult to perform due to the anatomical situation of a maximally elevated bladder neck. (4)If a hyperreflexive detrusor is combined with a weak sphincter, again urinary incontinence is the greatest problem. To begin with, elimination of detrusor hyperreflexia is mandatory and can often only be accomplished by surgery, either by bladder augmentation using an isolated detubularised segment ofileum serving as energy destroyer, or by sacral posterior root rhizotomy. Sometimes the elimination of detrusor hyperreflexia in combination with CIC provides a socially acceptable situation, but neurogenic urinary stress incontinence has to be treated by an artificial urinary sphincter. (5)Finally, in patients with incomplete spinal cord lesions intravesical electrotherapy (Katona, 1975), based on receptor depolarisation contributes greatly to the rehabilitation of the neuropathic bladder. In children with myelo- or sacral dysplasia this method together with biofeedback is an indispensible tool within a complex training programme for bladder rehabilitation. The increased therapeutic armentarium is responsible for the changing concepts in the treatment of neuropathic detrusor and sphincter dysfunction, and moreover offers the possibility of choice for the same type of neuropathic bladder but with special respects for the individual needs of the patient. It should be stressed that adequate primary care is the prerequisite for successful application of these new treatment strategies and that functional and morphological changes do also occur with these types of therapy, and therefore lifelong urological care is necessary.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
平凡完成签到,获得积分10
1秒前
2秒前
哈利波特完成签到,获得积分10
5秒前
菓小柒完成签到 ,获得积分10
5秒前
basil完成签到,获得积分10
6秒前
大橙子发布了新的文献求助10
6秒前
mammer应助超帅无色采纳,获得10
7秒前
helloworld完成签到,获得积分10
8秒前
海洋完成签到,获得积分10
8秒前
Hina完成签到,获得积分10
9秒前
ZH完成签到,获得积分10
12秒前
yyds完成签到,获得积分10
13秒前
量子星尘发布了新的文献求助10
15秒前
16秒前
唯梦完成签到 ,获得积分10
16秒前
詹姆斯哈登完成签到,获得积分10
19秒前
李健应助名字不好起采纳,获得10
21秒前
万历完成签到,获得积分10
21秒前
21秒前
林卷卷完成签到,获得积分10
22秒前
大葱鸭发布了新的文献求助10
24秒前
25秒前
李健应助南山无梅落采纳,获得10
25秒前
29秒前
赘婿应助大橙子采纳,获得10
31秒前
38秒前
我是大学霸完成签到,获得积分10
39秒前
随风完成签到,获得积分0
39秒前
yi完成签到 ,获得积分10
40秒前
lin完成签到,获得积分10
41秒前
huahua完成签到 ,获得积分10
41秒前
大橙子发布了新的文献求助10
44秒前
小黑完成签到,获得积分10
47秒前
ZY完成签到 ,获得积分10
50秒前
阿士大夫完成签到,获得积分0
50秒前
chai完成签到,获得积分10
50秒前
GUO完成签到,获得积分10
51秒前
111完成签到 ,获得积分10
52秒前
Llllll发布了新的文献求助200
53秒前
天下无马完成签到 ,获得积分10
54秒前
高分求助中
【提示信息,请勿应助】关于scihub 10000
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 3000
徐淮辽南地区新元古代叠层石及生物地层 3000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Handbook of Industrial Diamonds.Vol2 1100
Global Eyelash Assessment scale (GEA) 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 550
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4038157
求助须知:如何正确求助?哪些是违规求助? 3575869
关于积分的说明 11373842
捐赠科研通 3305650
什么是DOI,文献DOI怎么找? 1819255
邀请新用户注册赠送积分活动 892655
科研通“疑难数据库(出版商)”最低求助积分说明 815022