Article

[Bladder deformations in neurogenic bladder secondary to cauda equina or conus medullaris lesion].

Service de rééducation neurologique et d'explorations périnéales, hôpital Rothschild, groupe hospitalier universitaire Est, AP-HP, 33, boulevard de picpus, 75012 Paris, France.
Progrès en Urologie (Impact Factor: 0.8). 06/2010; 20(6):450-7. DOI: 10.1016/j.purol.2010.01.002
Source: PubMed

ABSTRACT The bladder deformations observed in the neurogenic bladders are frequent, particularly in the "upper motor neuron" bladder type (paraplegia, multiple sclerosis). We wanted to verify the predictive factors of such damage and particularly, if the urodynamic typology intervened in their genesis by using the model of cauda equina syndrome and conus medullaris lesions.
We have studied retrospectively the presence of cystographic bladder deformations at patients with neurogenic bladder due to cauda equina syndrome or conus medullaris lesion according to their urodynamic status: either overactive or acontractile detrusor.
Of 68 patients, (mean age 47.2 years), 34 had an overactive and 34 an acontractile detrusor. The presence of bladder deformations was associated with an overactive detrusor (p=0.04). However, 50% of the patients with acontractile detrusor had bladder deformations, and those deformations were associated with male sex, and this excluding urologic obstruction.
This study demonstrates the existence of bladder deformations in the hypoactive lower motor neuron neurogenic bladder type. If the bladder deformations seem more frequent in the overactive neurogenic bladder type, their specific and repeated search is also necessary during the follow-up of the lower motor neuron neurogenic bladder type.

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    ABSTRACT: Abstract Objective Neurogenic bladder refers to morphofunctional alterations of bladder-sphincter complex secondary to central or peripheral neurological lesions. Discal etiology can be suggested by clinical observation in patients complaining classical lower back pain, but not excluded even without musculoskeletal pain. This review provides a brief overview of associations between neurogenic bladder and disc disease, analyzing neuroanatomy, pathophysiology, clinical and urodynamic findings. Therapy is revised focusing on aetiological treatments. Methods The literature search has been performed on PubMed, Medline and Google scholar using the following keywords: 'neurogenic bladder', 'disc herniation', 'disc prolapse', 'disc protrusion', 'cauda equina syndrome', 'treatment', 'surgery', 'urodynamic', either alone or in combination using "AND" or "OR". The reference lists of articles retrieved were examined to capture other potentially relevant articles. The search has been restricted to articles published between 1970 and 2012. 79 papers have been found, but only 42 have been reviewed and summarized. Findings The literature revised confirmed correlations between neurogenic bladder and disc disease. Approximately 40% of patients with lumbar disc disease haveabnormal urodynamic testing, and even larger proportion complain voiding symptoms. The most common urodynamic finding is detrusor areflexia, but underactive or overactive detrusor can also be observed. Electromiography can reveal perineal floor muscle innervation abnormalities. Chronic nervous damage induces reduction of bladder sensitivity and detrusor atrophy. A overdistension of bladder follows, with global and circumferential thinning of thickness. Overactive detrusor is related to early nerve roots stretching causing irritative state responsible for overstimulation and neurogenic overactivity. Correlated anatomical deformations could be represented by detrusor hypertrophy. Conclusions Benefits for neurogenic bladder obtained through disc disease treatment should be studied in more detail, especially conservative therapies, not yet discussed in literature. Spine surgery effectiveness on voiding function should be valued in the light of the latest surgical techniques, considering the controversial results reported after laminectomy.
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