[Bladder deformations in neurogenic bladder secondary to cauda equina or conus medullaris lesion].
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: Objective To clarify bladder and bowel function of children with lipomas of the conus, without, before and after neurosurgery. Patients and methods Retrospective analysis of 114 children with a lipomas of the conus, followed in our pediatric neuro-urology department from 1993 to 2010. Several data were collected: bladder and bowel symptoms, bladder and anorectal continence, neurosurgical indication and age, clinical modification after neurosurgery, investigations carried out in pre- and post-surgery treatment, associated bladder and bowel treatment. Results Forty-nine of the 77 children (63.6%) operated on had never been seen before surgery in our neuro-urology department. Seventy-seven children (67.5%) underwent a neuro-surgery, 60% indicated due to a neurogenic bladder. Before neurosurgery, 66 children (85.7%) had spontaneous miction. Five children (6.5%) had bladder intermittent catheterization. Forty of these patients (56.3%) were continent. After neurosurgery and a specialized consultation in neuro-urology, 54 children (70.1%) were continent. Thirty-seven children (48%) had spontaneous miction. Thirty-seven children (48%) had bladder intermittent catheterization and drug of overactive detrusor. Fifty-two children (67.5%) were constipated after surgery. Seventy-seven percent of the treatments for bowel symptoms were effective in terms of continence. Conclusion The existence of a neurogenic bladder was one of the main indications for neurosurgery. These results suggest that the complexity of care requires neurosurgical, urological surgeon and neuro-urology physician to achieve the explorations and urinary and digestive treatment in order to preserve renal function and both continences.Progrès en Urologie 04/2012; 22(5):291–300. DOI:10.1016/j.purol.2011.12.001 · 0.66 Impact Factor
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ABSTRACT: Objective To study the intrinsic diagnostic value of the exams performed to explore bladder outlet obstruction in women. Methods Review of literature (PubMed, Embase, Cochrane Database) using following keywords: female, bladder outlet obstruction, post-void residual, uroflowmetry, flow pattern, cystoscopy, MRI, retrograde cystography, bladder wall thickness, bladder trabeculation, urinary retention, voiding cystometry, pressure flow studies, electromyography. Among 2660 articles (animal and anatomical studies have been excluded), 40 have been selected because they focused on the evaluation of the intrinsic value of exams. Results The concomitant recording of bladder and abdominal pressure during voiding (pressure flow study) is useful to diagnose an hypocontractile detrusor, abdominal pressure efforts during voiding and obstruction (low voiding flow associated with a high bladder pressure). The reproducibility of pressure flow studies seems to be very good in the literature. Nomograms have been described to assess a possible obstruction, but some studies show no correlation between the severity of symptoms of bladder outlet obstruction and results on the main nomogram (nomogram of Blaivas). The measurement of the thickness of the bladder wall appears correctly correlated to the diagnosis of obstruction but measures vary significantly depending on the abdominal or vaginal ultrasonographic approach. Conclusion In literature, only methods of measurement of maximum urinary flow rate and post-void residual volume have been extendedly studied.Progrès en Urologie 10/2012; 22(11):628–635. DOI:10.1016/j.purol.2012.08.005 · 0.66 Impact Factor
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ABSTRACT: Objective: Neurogenic bladder refers to morphofunctional alterations of the bladder-sphincter complex secondary to central or peripheral neurological lesions. Discal etiology can be suggested by clinical observation in patients complaining of 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 reviewed focusing on etiological treatments. Methods: The literature search was 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 was restricted to articles published between 1970 and 2012. Seventy-nine papers were found, but only 42 were reviewed and summarized. Findings: The literature reviewed confirmed correlations between neurogenic bladder and disc disease. Approximately 40% of patients with lumbar disc disease have abnormal urodynamic testing, and an even larger proportion complain of voiding symptoms. The most common urodynamic finding is detrusor areflexia, but underactive or overactive detrusor can also be observed. Electromyography can show perineal floor muscle innervation abnormalities. Chronic nervous damage induces reduction of bladder sensitivity and detrusor atrophy. An overdistension of the bladder follows, with global and circumferential thinning of the bladder wall. Overactive detrusor is related to early nerve roots stretching causing an irritative state responsible for overstimulation and neurogenic overactivity. Detrusor hypertrophy is the anatomical deformation correlated. 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.Current Medical Research and Opinion 05/2013; 29(8). DOI:10.1185/03007995.2013.807788 · 2.65 Impact Factor