Neurogenic Bladder.pptx 2f1q2n

Neurogenic Bladder is the loss of normal bladder function due to damage to some of its nervous system.

The human bladder has two main functions, namely the storage and emptying of urine. Physiologically, in the process of urination there are four conditions that must be fulfilled to be normal, namely: 1. Adequate bladder capacity, 2. perfect bladder emptying, 3. takes place in good control, and 4. every filling and emptying of the bladder is not adversely affects the upper urinary tract and kidneys.

Ethiology There are 2 types of neurogenic bladder 1. Spastic - Caused by lesions above the center of the micturition in the sacral. - Loss of sensation to empty the bladder and lose motor control, - Bladder can be atrophy, so bladder capacity decreases. Clinical Appearance: • Frequent urinary voiding • Small capacity <300 cc • Small amounts

2. Flaccid - Lower motor neuron lesions - Bladder continues to be filled and enlarged (extension) - Urine is collected and can become empty but incomplete (overflow), causing the amount of residual urine to trigger potential for infection.

Anormalities in the central nervous system: • Alzheimer's disease • Meningomielocele • Brain tumor or spinal cord • Multiple sclerosis

Disorders of the peripheral nervous system: • Alcoholic neuropathy • Diabetes neuropathy • Nerve damage due to pelvic surgery

Patophysiology Depending on the path affected, in general there are three main types of interference

1. Supersons punch The center of the micturition is the center of setting mycotic reflexes and all of its activity is regulated mostly by inhibitory input from the medial frontal lobe, basal ganglia and elsewhere. Damage in general will result in loss of inhibition and cause hyperreflection 2. Lesions between the center of the micturition and the sac spinal cord Spinal cord lesions located between the center of the micturition and the sacral portion of the spinal cord will interfere with the pathway which inhibits detrusor contraction and the regulation of the detrusor sphincter function. Some conditions that might occur include:

1. Vesica urinaria is hyperreflection As with supra-ponsy lesions, the loss of the normal inhibitory mechanism will lead to a hyperreflection bladder state that will cause pressure to increase in small increments of the volume of the bladder. 2. Disinergia detrusor-sphingter (DDS) Under normal circumstances, sphincter relaxation will precede detrusor contractions. In the DDS state, there are contractions of the sphincter and detrusor muscles simultaneously. 3. A weak detrusor contraction Hyperreflection contractions that arise are often weak so that emptying the bladder that occurs is not perfect. This situation when combined with disinergia will cause an increase in residual volume after micturition. 4. Increasing the volume of residual post-injection A large volume of residual after-injection in hyperreflection bladder conditions requires a little additional volume for bladder contractions to occur. Patients complain about frequent small amounts of micturition.

3. Lower Motor Neuron lesion (LMN) Damage to the S2-S4 root in both the spinal and extradural canals will cause LMN interference from the bladder function and loss of bladder sensibility. The voluntary process of micturition is lost and because the mechanism for causing detrusor contractions is lost, the bladder becomes atonic or hypotonic when the damage to the damage is partial.

Symptoms • Neurogenic bladder is characterized by spontaneous voiding in small amounts at frequent intervals. This voiding pattern reflects the presence of upper motor neuron lesions (Engram, 1999) • Symptoms vary based on whether the bladder becomes less active or overactive. An underactive bladder is usually not empty and stretched until it becomes very large. This enlargement usually does not cause pain because stretching occurs slowly and because the bladder has little nerve or does not have local nerves.

Diagnosis • History • Evaluation : Physical examination included > regular check-ups in bed > careful evaluation of genitalia and prostate > perineal sensation > anal tone

There are several ways of evaluating reflexes that are useful for determining the state of the patient Ice Water Test: • To test for bladder autonomic function through the pelvic nerves • 3 ounces (150 cc) of saline liquid with a temperature of 380 F or 3.30 C is injected into a catheter in the bladder. • If the saline solution comes out quickly, the test shows a description of UMN's condition

Bulbocavernosus Reflex: • This test is for the somatic function of the bladder through the pudendal nerve. • The finger is inserted into the rectum and the pensi gland or the clitoris is pressed or the catheter is pulled. • If the rectal sphincter contracts, there is no possible reflex activity and LMN lesions Residual Urine: • This examination shows the perfection of bladder emptying. • After emptying the bladder, the patient is immediately catheterized. • Residual urine is normally negligible. • Large values ​of 10-20%, often seen in Neurogenic Bladder, are usually not acceptable. • This shows incomplete emptying of the bladder, remaining urine allows a place for infection to occur

Radiographic Inspection: • The most common way is a static cystogram to examine the anatomy of the urinary tract. • Voiding cystourethrogram to test the function of the urethra and bladder during emptying. • Retrograde urethrogram for detecting strictures, reflexes or diverticuli. • Sphincterometry to measure the resistance given by the sphincter. Urodynamic Test: • Cystometrograph is a useful guide for treating neurogenic bladder and also for classification. • It provides a volume-pressure curve pattern that shows sensation, filling pressure, detrusor capacity and contraction.

Treatment The main goal, without considering the etiology and level of diagnosis, is to maintain kidney function This can be done by improving the function of the bladder cycle and emptying completely. • Prevention of urinary tract infections and bladder overdistention is an integral part of the rehabilitation program, by finding a urine expenditure method that is tailored to the needs of each patient. • Internal catheters (intermittent or indwelling) are used only if the urine is still stuck in the bladder. • Inkontinesia can often be treated in men using catheter condoms and in women wearing diapers.

• If the catheter is indispensable, intermaitten catheters are more important than indwelling catheters because they reduce infection and complications, and accelerate bladder retraining complication • bladder cancer • ISK • Hidronefrosis • etc Prognosis • Prognosis is good if the disorder is diagnosed and treated before kidney damage.