Neurogenic bladder dysfunction is a violation of the normal functioning of the organ. Pathology is quite widespread. In urology and pediatrics, about 10% of all diseases of the urinary system are occupied by this disease. At the same time, the risk of changes in the organs of the system of the secondary type is increased. Urination disorder is caused by a violation of the nervous regulation at the peripheral or central level. Next, consider what constitutes neurogenic bladder dysfunction at a younger age.
General information
Neurogenic bladder in women is caused by difficult childbirth, surgical interventions of a gynecological nature, as well as chronic pathologies of the pelvic organs. The disease may appear suddenly or progress gradually. Neurogenic bladder in men often occurs against the background of prostate adenoma, as well as after prolonged activity associated with lifting weights. In pathology, a person observes the excretion of urine drop by drop and the inability to keep it in stressful situations. A neurogenic bladder in a child may have a primary form. In this case, hereditary nervous pathologies act as a provoking factor. Urination disorder 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
A child has a fully controlled mature urination pattern by the age of 3-4 years. The system goes through several stages of development - from the spinal unconditioned reflex to the voluntary reflex act. The regulation of fluid discharge involves subcortical and cortical brain centers, zones of spinal innervation in the lumbosacral spinal cord, as well as peripheral nerve plexuses. Neurogenic bladder in a child is accompanied by disorders of innervation and reserve-vacuum processes. Pathology can provoke a number of serious diseases. These include, in particular, chronic kidney failure, pyelonephritis, cystitis, hydronephrosis, megaurethra, vesicoureteral reflux.
Provoking factors
Neurogenic bladder dysfunction develops as a result of various neurological disorders. They lead to a decrease in the coordination of the activity of the external sphincter or detrusor during the accumulation and release of fluid. Neurogenic bladder in a child can develop onagainst the background of CNS lesions of an organic nature. 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. The ailments against which a neurogenic bladder develops in a child include spinal hernias, birth injuries, dysgenesis and agenesis of the coccyx and sacrum, cerebral palsy and others. They lead to complete or partial dissociation of the spinal and supraspinal nerve centers and the organ. Most often, pathology is found in girls. This is due to increased estrogen saturation, which increases the sensitivity of detrusor receptors.
Classification
In accordance with changes in the bladder reflex, there are several types of pathology. With a hyperreflex bladder, a spastic state occurs in the stage of fluid accumulation. The hyporeflex type of pathology is accompanied by detrusor hypotension in the release phase. It is characterized by the occurrence of a reflex to urinate with a functional volume of the bladder, significantly larger than normal for age. With hyperreflexia, the appearance of a reaction is noted long before the accumulation of the prescribed amount of fluid. The reflex type of pathology is considered the most severe. It is accompanied by the impossibility of independent contraction of an overflowing and full bladder, as well as an involuntary act of emptying. Pathology is also classified according to the degree of adaptation of the detrusor to an increasing volume of fluid. So, the neurogenic bubble can beunadapted (non-inhibited) and adapted. There are also several forms of the disease. In particular, with a mild form, the patient spontaneously empties the bladder during stressful situations. Symptoms of a severe form are the development of Hinman's syndromes - detrusor-sphincter dyssenergy, Ochoa - urofacial pathology. In moderate forms, instability of the organ's activity is noted.
Clinical picture of hyperreflexia
What happens when the bladder is unstable? Symptoms of pathology are manifested in violations of the act of emptying. Their severity and frequency of occurrence are determined in accordance with the degree of nerve damage. Neurogenic hyperactivity usually predominates in young children. In this case, frequent emptying (up to eight times a day) of small volumes, imperative (urgent) urges, enuresis, and incontinence are observed. Postural neurogenic bladder, the symptoms of which appear when the body changes from horizontal to vertical, is accompanied by daytime pollakiuria, as well as undisturbed accumulation of urine at night with a normal morning portion. Stress incontinence is characterized by the loss of a small amount of fluid. This phenomenon can appear during physical exertion. Against the background of detrusor-sphincter dyssenergy, there is an absolute delay or incomplete emptying, as well as micturition (urination) during straining.
Manifestations of hyporeflexia
Against the background of this type of pathology, rare ormissing urination with an overflowing or full bladder. Emptying may also be sluggish, with tension in the peritoneal wall. Often there is a feeling of incomplete urination. This is due to the large volume of the residue (up to 400 ml). In some children, paradoxical ischuria is likely, accompanied by an uncontrolled output of urine. This is due to the gaping of the external sphincter, which is stretched under the pressure of a crowded organ. With a lazy bladder, rare urination is noted, combined with incontinence, tract infections, and constipation. In the 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 secondary kidney shrinkage, chronic insufficiency and nephrosclerosis.
Diagnosis
When urination disorders appear, it is necessary to conduct a comprehensive examination. It should involve such doctors as a pediatrician, psychologist, neurologist, nephrologist, urologist. Diagnosis includes taking an anamnesis. A family predisposition to the development of pathology is revealed, whether there were injuries, diseases of the nervous system, and so on. The results of instrumental and laboratory studies are also evaluated. To detect infection and functional renal disorders against the background of pathology, a biochemical analysis of blood and urine, a test according to Nechiporenko, Zemnitsky, as well as bacteriological analysis are carried out. Urological examination includes ultrasound. The kidneys and bladder are examined with the determination of the residual volume. also inexamination included X-ray diagnostic method. Perform excretory and review urography, voiding cytography. CT and MRI of the renal system, endoscopy, radioisotope scanning are also performed. Assessment of the state of the bladder is carried out by monitoring the daily volume and rhythm of spontaneous urination under normal temperature and drinking conditions. 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) are of high diagnostic significance in identifying the disease. Echo-EG, EEG, MRI of the brain, X-ray of the spine and skull are also performed for suspected neurogenic bladder in children. Komarovsky in one of his articles describes clinical analysis (CAM) in detail.
Therapeutic interventions
They are prescribed according to the type, severity of disorders, comorbidities. As a rule, differentiated tactics are used. Many experts prescribe homeopathic remedies. However, there are some doctors who do not trust these remedies. For example, he does not recommend homeopathic preparations if a neurogenic bladder is detected in children, Komarovsky. It should be said that the doctor is generally skeptical about this kind of therapy. However, there are many cases in practice when homeopathy has been very effective. Timely diagnosis and correctly chosen tactics of therapy allows sufficientquickly eliminate the pathology.
Medication effects
To eliminate hypertonicity, patients are prescribed M-cholinoblockers. These include such medicines as "Atropine", "Oxybutynin" (for patients from the age of five). Also shown are tricyclic antidepressants (for example, Melipramin), Ca + antagonists (these include drugs Nifedipine, Terodilin), nootropics (among them drugs Picamilon, 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 the main therapy, as well as alleviate the condition with the least risk, since it has a minimum of side effects. In the presence of nocturnal enuresis, patients from the age of five can be prescribed an analogue of the antidiuretic steroid of the neurohypophysis - desmopressin. To prevent the development of infection, patients are recommended small doses of uroseptics. These include, in particular, nitrofurans (Furagin drug), oxyquinolones (5-NOC drug), fluoroquinolones (nalidixic acid), Canephron drug, immunocorrective effect (Taktivin, Levamisole drugs).
Extra
To alleviate the condition, urination is scheduled according to a schedule in 2-3 hours. Also shown are regular catheterizations, the use of cholinomimetics, anticholinesterase drugs,adaptogens. Baths with medicinal sea s alt are recommended.
Operative methods
In case of neurogenic bladder, endoscopic interventions are performed. In particular, transurethral resection of the neck of the organ, implantation of collagen at the mouth of the urethra, intraurethral and intradetrusive injections of botulinum toxin are performed. Interventions are also performed on the nerve ganglia, which are responsible for urination. With the help of intestinal cystoplasty, an increase in the volume of the bladder is performed.
