Neurogenic bladder dysfunction is a violation of the normal functioning of the organ. Pathology is quite widespread. In urology and pediatric pediatrics, about 10% of all diseases of the urinary system occupy this particular ailment. Along with this, the risk of changes in the organs of the secondary type system is increased. The 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 young age.
General information
Neurogenic bladder in women is caused by difficult births, 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 weight lifting. With pathology, a person observes the excretion of urine dropwise and the inability to keep it in stressful situations. The neurogenic bladder in a child may have a primary form. In this case, hereditary nervous pathologies act as a provoking factor. Urinary distress at a young age can be secondary. In this case, the formation of pathology occurs under the influence of exogenous or endogenous factors.
Reflex formation
In a child, a fully controlled mature urination regimen is formed by 3-4 years of age. The system goes through several stages of development - from the spinal unconditioned reflex to the voluntary reflex act. Subcortical and cortical brain centers, spinal innervation zones in the lumbosacral spinal cord, as well as peripheral nerve plexuses participate in the regulation of fluid discharge. 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.
Provocative factors
Bladder neurogenic dysfunction develops due to various neurological disorders. They lead to a decrease in the coordination of activity of the external sphincter or detrusor during the accumulation and release of fluid. A child's neurogenic bladder can develop amid organic central nervous system lesions. They, in turn, can be triggered by injuries, inflammatory-degenerative and tumor 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 organ. Most often, pathology is found in girls. This is due to increased estrogen saturation, which enhances the sensitivity of detrusor receptors.
Classification
In accordance with changes in the cystic reflex, several types of pathology are distinguished. 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 isolation phase. It is characterized by the appearance of a reflex to urination with a functional volume of the bladder that is significantly larger than normal by age. With hyperreflection, 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 a full and full bladder, as well as an involuntary act of emptying. Pathology is also classified in accordance with the degree of fitness of the detrusor to an increasing volume of fluid. So, a neurogenic bubble can be non-adapted (non-inhibited) and adapted. Several forms of the disease are also distinguished. In particular, when the patient is mild, the bladder empties spontaneously in stressful situations. Symptoms of a severe form are the development of Hinman's syndromes - detrusor-sphincter disserneria, Ochoa - urofacial pathology. With moderate forms, the instability of the activity of the body is noted.
The 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 prevails 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 horizontal position of the body changes to vertical, is accompanied by daytime pollakiuria, as well as undisturbed accumulation of urine at night with a normal volume of morning portion. Stress incontinence is manifested by the loss of a small amount of fluid. This phenomenon may occur during physical exertion. Against the background of detrusor-sphincter dissenergy, there is an absolute delay or incomplete emptying, as well as myctions (urination) during straining.
Manifestations of hyporeflexia
Against the background of this type of pathology, rare or absent urination with a full or full bladder is noted. Emptying can also be sluggish, with tension on the peritoneal wall. Often there is a feeling of incomplete urine output. 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 release of urine. This is due to the gaping of the external sphincter, which stretches under the pressure of an overflowing 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 inflammation, impaired blood flow in the kidneys, scarring of the parenchyma and the formation of secondary wrinkling of the kidney, chronic insufficiency and nephrosclerosis.
Diagnostics
When urination disorders occur, a comprehensive examination is necessary. Such doctors as a pediatrician, psychologist, neurologist, nephrologist, urologist should be involved in it. Diagnosis includes a medical history. 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 performed. Urological research includes ultrasound. The kidneys and bladder are examined to determine the residual volume. An X-ray diagnostic method is also included in the examination. Perform excretory and survey urography, mikitsionny cytography. CT and MRI of the renal system, endoscopy, and radioisotope scanning are also performed. Assessment of the condition 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, and cystometry (retrograde) are of high diagnostic value in identifying the disease. Echo-EG, EEG, MRI of the brain, X-ray of the spine and skull are also performed with suspected neurogenic bladder in children. Komarovsky in one of his articles describes in detail clinical analysis (OAM).
Therapeutic measures
They are prescribed in accordance with the type, severity of disorders, concomitant diseases. As a rule, differentiated tactics are used. Many experts prescribe homeopathic medicines. However, there are also such doctors who do not trust these funds. For example, it does not recommend homeopathic remedies if neurogenic bladder is detected in children, Komarovsky. It should be said that the doctor is generally skeptical of this kind of therapy. Nevertheless, there are many cases in practice when homeopathy was very effective. Timely diagnosis and the right tactics of therapy can quickly eliminate the pathology.
Drug exposure
To eliminate hypertension, patients are prescribed M-anticholinergics. These include medicines such as Atropine, Oxybutynin (for patients from five years old). Also shown are tricyclic antidepressants (for example, Melipramine), Ca + antagonists (these include Nifedipine, Terodilin), nootropics (among them are 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, and also with the least risk to alleviate the condition, since it has a minimum of side effects. In the presence of nocturnal enuresis, patients from the age of five can be prescribed an analog of the antidiuretic steroid of the neurohypophysis - desmopressin. To prevent the development of infection, small doses of uroseptics are recommended for patients. These include, in particular, nitrofurans (Furagin), oxyquinolones (5-NOC), fluoroquinolones (nalidixic), Kanefron, immunocorrective effects (Taktivin, Levamisole medicines) .
Additionally
To alleviate the condition, urination is prescribed according to the schedule after 2-3 hours. Regular catheterization, the use of cholinomimetics, anticholinesterase drugs, adaptogens are also indicated. Recommended baths with therapeutic sea salt.
Operational methods
With a 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, and intraurethral and intratruder injections of botulinum toxin are performed. Interventions are also performed on the nerve ganglia, which are responsible for urinating. With the help of intestinal cystoplasty, an increase in the bladder is carried out in volume.