Neurogenic dysfunction of the lower urinary tract (neurogenic bladder)

The lecture presents information about the central and peripheral structures that provide innervation and regulation of the functions of the lower urinary tract — the bladder and urethra. The mechanisms of regulation of the functions of accumulation and retention of urine (reservoir function) and emptying of the bladder (evacuation function) are shown.Neural control of urination is organized in the form of a hierarchical system. The spinal centers are the executive structures, and the cerebral centers are the controlling structures. Involuntary implementation of the act of urination occurs through segmental sympathetic and parasympathetic mechanisms. The regulation of these functions and voluntary urination are carried out by the central mechanisms of the brain — the actuation of the urination reflex is under strict volitional control, which makes it possible to plan the emptying of the bladder in a socially acceptable place and time.The information on the clinical symptoms of neurogenic dysfunction of the lower urinary tract (neurogenic bladder) is reviewed. The features of clinical manifestations depending on the level of damage to neural structures and in various neurological diseases are shown. Methods for assessing urodynamics and treatment directions for neurogenic dysfunction of the lower urinary tract are presented.

CURRENT STATE OF THE PROBLEM OF DRAINAGE FOR NEUROGENIC BLADDER

Данный литературный обзор посвящен одной из актуальных проблем современной урологии - нейрогенной дисфункции мочевыводящих путей. Нейрогенная дисфункция нижних мочевыводящих путей является одной из важнейших проблем современной урологии, что обусловлено ее высокой распространенностью, частотой вторичных осложнений со стороны мочевыделительной системы и социально-экономической значимостью. Распространенность нейрогенного мочевого пузыря среди пациентов, перенесших острое нарушение мозгового кровообращения, варьирует от 15 % до 94 % и зависит от времени, прошедшего с момента сосудистого события. В статье представлены патофизиологические механизмы, лежащие в основе данной патологии, подробно рассмотрены современные методы дренирования нижних мочевыводящих путей, их преимущества и недостатки. К современным способам дренирования при нейрогенных расстройствах нижних мочевыводящих путей относят периодическую (интермиттирующую) катетеризацию, постоянную катетеризацию и надлобковую цистостомию. Анализ доступной литературы указывает на то, что частота осложнений, ассоциированных как с нейрогенной дисфункцией мочевого пузыря, так и с используемыми способами дренирования, продолжает оставаться достаточно высокой. Таким образом, проблема профилактики катетер-ассоциированных осложнений и улучшения качества жизни данной категории больных на сегодняшний день продолжает оставаться актуальной и требует проведения дальнейших исследований в данной области This literature review is devoted to one of the most pressing problems of modern urology - neurogenic urinary tract dysfunction. Neurogenic dysfunction of the lower urinary tract is one of the most important problems of modern urology, due to its high prevalence, frequency of secondary complications from the urinary system, and socio-economic significance. The prevalence of neurogenic bladder among patients who have experienced acute cerebrovascular accident varies from 15 % to 94 % and depends on the time elapsed since the vascular event. The article presents the pathophysiological mechanisms underlying this pathology, discusses in detail modern methods of drainage of the lower urinary tract, their advantages and disadvantages. Modern methods of drainage for neurogenic disorders of the lower urinary tract include periodic (intermittent) catheterization, permanent catheterization, and suprapubic cystostomy. Analysis of the available literature indicates that the frequency of complications associated with both neurogenic bladder dysfunction and the drainage methods used continues to be quite high. Thus, the problem of preventing catheter-associated complications and improving the quality of life of this category of patients continues to be relevant today and requires further research in this area

Catheters for intermittent bladder catheterization, as a technical tool for rehabilitation of patients with neurogenic lower urinary tract dysfunction: issues of the organization of disabled providing

Bladder emptying dysfunction accompanies many neurological diseases. Such bladder dysfunction leads to the risk of serious complications developing which can negatively affect neurorehabilitation. The main method of treating neurogenic bladder emptying dysfunction is periodic catheterization. When periodic catheterization is going to be used, preference should be given to modern lubricant catheters with fixed hydrophilic coating. According to the law of Russian Federation, disabled people can receive such catheters for free as a technical tool of rehabilitation. The article discusses the law aspects of obtaining catheters for periodic catheterization by a disabled person with lower urinary neurogenic dysfunction.

Neurogenic Bladder Dysfunction in Cancer Patients after Operations on the Pelvic Organs

The review is devoted to the generalization and analysis of domestic and foreign works describing the mechanism of development of neurogenic dysfunction of the bladder after surgery on the pelvic organs in cancer patients. All modern authors agree that the cause of these disorders is trauma of the pelvic nerves and interruption of the reflex arc. Unfortunately, when removing malignant tumors of the pelvic organs, urological complications are difficult and often impossible to avoid. This is due to the complex neuroanatomy of the bladder, its proximity to the rectum, the uterus, as well as the volume and radicality of cancer operations. The article shows that if the parasympathetic ganglia are damaged, there is a violation of the evacuation function of the bladder and a weakening or absence of the urge to urinate. If the sympathetic nervous system is damaged in isolation, on the contrary, an increase in the detrusor tone, intravesical pressure and a decrease in the capacity of the bladder is observed, which is in conditions of low bladder sphincter tone causes imperative urges, frequent urination and incontinence. Prior radiation therapy also affects the development of urological complications. Postradiated soft tissue changes, ischemia, fibrosis lead to great technical difficulties during surgery. In addition, factors that are important in the development of pelvic disorders in this category of patients include urinary system diseases and metabolic – endocrine disorders in case history.

The relationship between detrusor state and tone of the large intestine and their sphincter apparatus in women with hyperactive urinary bladder

The objective: increase the effectiveness of diagnosis and treatment of women with a hyperactive bladder, combined neurogenic pathology of the lower urinary tract and distal colon. Patients and methods. The study included 73 women. In assessing the symptoms of clinical manifestations and EMG and UFS data, two groups of patients were identified: the first group – women with increased tone of the neuro-muscular structures of the hyperkinetic type; the second group - women with an increased tone of the neuromuscular structures of the hypokinetic type. In the first group, 37 women were examined, whose mean age was 44.5±2.3 years, and the duration of the disease was 16.7±1.6 months. The second group included 36 women, whose average age was 43.4±2.1 years, and the average duration of the disease was 19.7±1.5 months. Results. The performed treatment showed clinically high efficiency of electrostimulation application depending on the state of the tone of the neuromuscular structures of the lower urinary tract and the distal part of the large intestine, which is confirmed by the data of UFS and EMG. Conclusion. The obtained data allowed to develop and optimize methods of treatment of women with hyperactive urinary bladder with a combined neurogenic pathology of the lower urinary tract and distal division of the large intestine. Key words: neurogenic disorders in urination, intestine neurogenic dysfunction, detrusor, uroflowmetry, electromyography.