About Neurogenic Bladder


Contents
Definition
About Neurogenic Bladder
Treatment
Further Information
Latest Research


 
Definition

Neurogenic bladder is a urinary problem in which the bladder does not empty properly. Depending on the type of neurological disorder causing the problem, the bladder may empty spontaneously (incontinence) or may not empty at all (retention with overflow leakage).

Some of the common causes for neurogenic bladder are nervous system tumor, trauma, neuropathy, or inflammatory conditions (such as multiple sclerosis).
http://www.nlm.nih.gov/medlineplus/ency/article/000754.htm

About Neurogenic Bladder

What is a neurogenic bladder?

A neurogenic bladder is a loss of normal control of bladder function caused by damaged nerves. There are 2 kinds of neurogenic bladder problems: overactive and underactive.

If you have an overactive bladder, you are not able to control when or how much you urinate.

If you have an underactive bladder, it holds much more urine than normal. Because you cannot feel when the bladder is full, you leak small amounts of urine as bladder pressure builds.
How does it occur?

Nerves and the muscles of the urinary system work together to hold urine in the bladder and then release it when you go to the bathroom. Nerves tell the brain when the bladder is full. The nerves carry messages from the brain to the muscles of the bladder, telling the muscles either to tighten or to release. In a neurogenic bladder, the nerves that carry these messages do not work properly.

Neurogenic bladder may be caused by:
* injuries or birth defects that affect the brain or spinal cord
* diabetes
* polio
* Parkinson's disease
* multiple sclerosis
* infection
* strokes
* heavy metal poisoning.

With an overactive or underactive bladder, you may not be able to empty your bladder completely. Urine that is held too long before being eliminated may lead to infections of the bladder or ureters. (The ureters are the tubes that carry urine from each kidney to the bladder). Urine may back up into the kidneys and damage them.
What are the symptoms?

Common symptoms of neurogenic bladder and the infections it can cause are:
* leaking or dribbling urine
* a frequent and urgent need to urinate
* pain or burning when urinating
* pain in the lower pelvis, stomach, lower back, or side
* change in the amount you urinate, either more or less
* chills
* fever.

How is it diagnosed?

Your health care provider will ask about your symptoms and will examine you. A sample of your urine may be tested. Your provider may test your nervous system (including the brain) and your bladder. These tests may include:
* x-rays, CT scan, or MRI scan of the skull and spine
* x-rays of the bladder and ureters
* EEG, a test that uses wires taped to your forehead to check the brain for seizures
* CMG (cystometrogram), a test that involves filling the bladder to see how much it can hold and then emptying the bladder to see if the bladder empties completely.
http://www.med.umich.edu/1libr/aha/aha_neurogen_crs.htm

Treatment

Treatment of a neurogenic bladder depends on:
* the type of bladder problems that you have
* the cause of the nerve damage
* your age, overall health, and medical history
* how severe your symptoms are.

Medicine may help control your symptoms. If you have an overactive bladder, your health care provider may prescribe drugs that relax the bladder, such as propantheline (Pro-Banthine) and oxybutynin (Ditropan). If you have an underactive bladder, you may be given a drug that stimulates a certain type of nerves. An example of such a drug is bethanechol (Urecholine). You may need to take antibiotics to prevent infections.

Long-term treatment for neurogenic bladder may include:
* Insertion of a catheter (thin tube) to empty the bladder. A small rubber catheter may be inserted 4 to 6 times a day to empty the bladder. This is called intermittent catheterization. A continuous catheter is another option. Continuous catheters are also called indwelling catheters. They empty the bladder continuously into a collection bag.
* Surgery to create an artificial sphincter. For this procedure, an artificial cuff is placed around the neck of the bladder. This cuff can be inflated to prevent urinary leakage and deflated when it is time to empty the bladder. You will still need intermittent catheterization to completely empty the bladder.
* Sacral nerve stimulation (SNS). For SNS, a small wire is inserted through the skin in the area around the tailbone. The wire allows the nerves to be stimulated to empty the bladder.
* Sling surgery. The surgeon creates a new support system, either from your own tissues or by using synthetic materials, to hold the neck of the bladder in the proper position and prevent leakage.

How long do the effects last?

In most cases you will need treatment for the rest of your life.

How can I take care of myself?

Follow your health care provider's advice on how much fluid you should drink.

Carefully follow your instructions for self-catheterization. This will help to prevent infections.

Contact your health care provider right away if:
You have symptoms such as:
* sweating, headache, and dizziness that do not go away after you empty your bladder
* fever of 101?F or higher
* worsening pain for several hours in the back or bladder area

* You cannot empty your bladder at all.
http://www.med.umich.edu/1libr/aha/aha_neurogen_crs.htm

Further Information

American Foundation for Urologic Disease
1128 North Charles Street
Baltimore, MD 21201
(800) 242-2383
Web site: http://www.afud.org

National Kidney Foundation
30 East 33rd Street
New York, NY 10016
(800) 622-9010
Web site: http://www.kidney.org

Latest Research


Contents
*Changing Composition Of Renal Calculi In Patients With Neurogenic Bladder
*SIU 2006 Cape Town South Africa: Society Of Genitourinary Reconstructive Surgeons: Reconstructive Surgery


 
Changing Composition Of Renal Calculi In Patients With Neurogenic Bladder

12 Jul 2006

Renal calculi are a not uncommon complication in patients with neurogenic bladder and this is often a significant source of morbidity. Traditionally, these calculi have been composed primarily of struvite and carbonate apatite secondary to chronic urea-splitting bacteria.

These Indianapolis researchers have reassessed the composition of renal calculi in a contemporary cohort of patients with neurogenic bladder due to spinal cord injury or myelomeningocele who underwent percutaneous nephrolithotomy. In this retrospective review of 32 patients with neurogenic bladder the stones were infectious in etiology in 37.5% and metabolic in 62.5%.

All the patients with struvite calculi were infected with urea-splitting bacteria on preoperative urine culture. The 20 patients with metabolically derived calculi included uric acid in 1, calcium oxalate monohydrate in 2, brushite in 2, hydroxyapatite in 6, and mixed hydroxyapatite/calcium oxalate in 9. In the modern era, with urodynamic evaluation of the detrusor and sphincter function, as well as increased understanding of neurogenic voiding dysfunction, the rate of urinary tract infections in the spinal cord injured and meningomyelocele patient populations has decreased.

The increased utilization of clean intermittent catheterization and bladder augmentation has allowed many patients formally at risk for renal deterioration to be maintained with low-pressure urinary drainage systems. All of the patients in this study population who developed struvite calculi had managed their urinary tract with either a chronic indwelling urethral catheter or a chronic suprapubic tube.

Therefore, it would appear that eliminating these types of urinary drainage, if at all possible, will be of great benefit to the patient in reducing the risk of infection stone. However, if a metabolically derived stone is identified, these patients should be offered further metabolic evaluation and appropriately selected medical and dietary therapy to attenuate their stone activity.

By Elspeth McDougall, MD
http://www.medilexicon.com/medicalnews.php?newsid=47001

SIU 2006 Cape Town South Africa: Society Of Genitourinary Reconstructive Surgeons: Reconstructive Surgery

01 Feb 2007

UroToday.com- The Society of Genitourinary Reconstructive Surgeons met with a theme entitled New Techniques in Reconstructive Urologic Surgery. The session was chaired by Allen Morey from San Antonio and Kenneth Angermeier from Cleveland.

Part two of the meeting was devoted to reconstructive surgery and ran two hours in length.

Dr. Steven Brandes from Washington University in St. Louis first lectured on the use of the vacuum assisted wound closure device in complex urologic and traumatic wounds. The first report using negative pressure wound therapy came in 1986 with the FDA approving a proprietary device in 1995. Dr. Brandes described uses of the device in the closure of wounds such as those after debridement in Fournier's gangrene and in cases of traumatic skin loss. The device entails placing polyurethane foam with 400-600 micron pores on the wound and covering it with an airtight barrier dressing under which a suction disc or fenestrated tubing is placed. The device is placed to intermittent suction at 25-200 mm Hg (typically 125 mm Hg) and the suction is cycled 5 minutes on and 2 minutes off to allow for capillary rest. The device was shown to significantly decrease the time for wound closure in a wound that was to be left to heal by secondary intention with wet to dry dressings- the rate of closure was 0.23 cm2/day vs. 0.09 cm2/day. The device also has some promise to improve time and take of skin grafts.

Reynaldo Gomez from Santiago Chile then discussed continent reconstruction of the neurogenic bladder in the spinal cord injury patient. Dr. Gomez discussed his experience from a major rehabilitation center in Santiago where full urinary continence is essential. The patients are treated extremely aggressively to restore continence with urinary diversions and CIC- sphincterotomies and condom catheters are not utilized. In patients with good urethras, good manual dexterity, and functional striated urethral sphincters, detubularized bladder augments are used. In those with damaged urethras, limited manual dexterity or no functional sphincter, augmentations and catherizable stomas or Indiana pouches are utilized. This aggressive management style is somewhat unique to this center but can serve as a model for the urologic treatment of this patient population.

Duncan Summerton from Leicester in the UK then lectured on the topic of reconstructive surgery in penile cancer. Dr. Summerton began with some startling data which shows that 20% of all cases of penile cancer still occur in males < 50 years old and 15-50% delay seeking treatment for 1 or more years. If left untreated, most will die in less than 2 years and all in les than 5 years. He cautioned that inadequate surgical treatment can lead to disastrous results and cautioned about the need for aggressive primary surgical excision followed by aggressive inguinal and pelvic node dissection if indicated. Some interesting concepts discussed were the use of a staging MRI with intracavernosal alprostadil injection to aid in the pre-operative staging and the capability of penile salvage with surgical margins of only 2 mm now acceptable to allow for phallic conservation.

George Webster from Duke then discussed salvaging continence after prostatectomy. He discussed the great numbers of radical prostatectomies that are performed in the US (80,000 in 2003) which has led to the unfortunate high numbers of men that suffer from post-prostatectomy incontinence. In his large series of 591 men undergoing artificial urinary sphincter placement (AUS), he has enjoyed an 89% success rate where men use 0 or 1 pad per day. The revision rate was 17% and largely secondary to a urethral fit problem. He discussed some surgical tips in revision surgery which include a transcorporal placement which allows for a tighter fit with less chance of urethral injury during dissection. He also is a great advocate for nocturnal deactivation to decrease the incidence of urethral atrophy- erosions were rare at 2.7%. He then discussed his experience with the new Advance Male Sling from AMS. This male sling, placed via a transobturator approach, has significant promise in men with mild to moderate incontinence (24 hour pad weight test of < 250 cc) and some residual external urethral sphincter activity as witnessed by cystoscopy pre-operatively.

Finally, Amr Fegany from the Cleveland Clinic discussed his experience with laparoscopic upper and lower urinary tract reconstruction. He described laparoscopic ureteroureterostomy, ureteroneocystotomy with and without a psoas hitch, boari flap and even laparoscopic ileal ureter substitution. In centers of excellence with experienced laparoscopic surgeons, Dr. Fegany showed that almost everything is now possible laparoscopically- the real challenge will be deciding when and where to utilize these techniques.

The Society of Genitourinary Reconstructive Surgeons Meeting closed with plans for a full program at the AUA 2007 in Anaheim.
http://www.medilexicon.com/medicalnews.php?newsid=62099



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