neurogenic bladder.pdf

06-Dec-23 Neurogenic Bladder Dr. 1 Normal function The lower urinary tract (LUT), urinary bladder, urethra, and periurethral striated muscles, serves two...

06-Dec-23 Neurogenic Bladder Dr. 1 Normal function The lower urinary tract (LUT), urinary bladder, urethra, and periurethral striated muscles, serves two important roles: 1. continence, the storage of urine in the bladder, 2. Micturition, efficient voiding of urine from bladder at appropriate time. 2 1  06-Dec-23 These functions are controlled by: 1. higher centers cortical inhibitory 2. Brainstem pontine micturition center 3. Neural circuits in the spinal cord, Engage the sympathetic (hypogastric nerve) L1,2 parasympathetic (pelvic nerve) S2,3,4 (pudendal nerve) somatic systems. S2,3,4 3 The bladder and sphincter(s) are controlled in a reciprocal manner: During storage, urine is retained in the bladder by action of sympathetic pathway producing bladder relaxation through the hypogastric nerve. somatic pudendal nerve produces coordinated contraction of the external urethral sphincter (EUS) 4 2  06-Dec-23 The bladder and sphincter(s) are controlled in a reciprocal manner: Initiation of voiding occurs when the parasympathetic pathway is activated, producing contraction of the detrusor muscle in the bladder through the pelvic nerve and the urethral sphincters are relaxed, allowing urine to leave the bladder and flow through the urethra. 5 6 3  06-Dec-23 1-Lesions at the level of the reflex arc (LMNL): 7 A-Lesions in the afferent fibers: -Sensory a tonic bladder -Absence of the sense of fullness of the bladder. -Retention of urine associated with a huge size of the bladder. -Dribbling of urine every now and then because of overflow. -Neurogenic detrusor over activity. 8 4  06-Dec-23 B- Lesions in the efferent fibers: -Motor a tonic bladder characterized by -Preservation of the sense of fullness of the bladder. -Retention of urine associated with a moderate size of the bladder. -Inability to evacuate bladder voluntarily. -Dribbling of urine every now and then because of overflow. -catheterization is usually quickly done. Sever pain 9 C-Lesion in both afferent and efferent fibers or in the spinal center -Autonomic or Autonomous bladder characterized by - incomplete, Irregular and Involuntary evacuation of the bladder as the evacuation of the bladder depend on its myogenic contraction. 10 5  06-Dec-23 2-Lesions above the level of the reflex arc (UMNL): 11 flaccid bladder: Acute spinal cord lesion due to spinal shock stage it is characterized by urinary retention and inactive bladder 12 6  06-Dec-23 spastic hyperactive bladder: in chronic spinal cord above centers controlling bladder frequent uncontrolled voiding (incontinence). After stabilized it is called automatic bladder in which there is regular complete evacuation of bladder still involuntary. 13 Un inhibited bladder: May occur in cortical lesion as in stroke, MS, head trauma. Lack of higher center inhibitory impulses leading to urinary frequency and urgency. 14 7  06-Dec-23 15 8