scholarly journals A neurogén húgyhólyag klinikuma és terápiás lehetőségei

2021 ◽  
Vol 162 (4) ◽  
pp. 135-143
Author(s):  
Péter Járomi ◽  
Tamás Banyó ◽  
Mihály Boros ◽  
Ferenc Papp ◽  
Andrea Szabó
Keyword(s):  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Autonomic Dysreflexia ◽  
Bladder Pressure ◽  
Lower Urinary Tract Dysfunction ◽  
Detrusor Contractility ◽  
Wide Range ◽  
Lower Urinary

Összefoglaló. Az alsó húgyutak fő funkciója a vizelet tárolása és ürítése, amely működések zavara az úgynevezett alsó húgyúti tünetegyüttes kialakulásához vezet, ami a kiváltó októl függően vizeletürítési zavarral és vizeletretencióval is járhat. Kezeletlen esetekben a felső húgyutak károsodása következik be a magas hólyagnyomás által kiváltott vesicoureteralis reflux következtében, amely ureter- és veseüregrendszeri tágulat kialakulására, illetve fertőzésekre és kőképződésre hajlamosít. A vizelettárolási/vizeletürítési zavarokat három fő csoportba sorolhatjuk, úgymint stressz- (terheléses) inkontinencia , hiperaktív hólyag (nedves/száraz) és neurogén hólyag. A jelen összefoglaló közlemény tárgyát képező neurogén hólyag egy gyűjtőfogalom, mely magában foglal minden, releváns neurológiai kórkép talaján kialakult vizelettárolási és vizeletürítési zavart. Mivel a húgyhólyag mellett a záróizomzat és a hátsó húgycső is érintett, ezt a kórképet napjainkban „neurogén alsó húgyúti diszfunkció” elnevezéssel is szokás illetni. A kórállapotot a neurológiai diszfunkciók széles spektruma okozhatja, kezdve a helyi funkcionális zavartól a helyi idegi sérülésen át a felső és alsó motoneuron-sérülésig vagy a centrális degeneratív folyamatokig. Az eltérő etiológia ellenére a klinikai tünetek rendszerint két alapvető klinikai típusban manifesztálódhatnak: túlműködő (fokozott detrusorkontraktilitást okozó automata) hólyag vagy alulműködő hólyag formájában. Tekintettel a neurogén alsó húgyúti diszfunkció következtében létrejövő felső húgyúti komplikációkra, a közlemény egyik célja a betegség diagnózisát segítő algoritmus bemutatása a legújabb nemzetközi szakirodalmi ismeretek alapján. A neurogén hólyag kezelése jobbára nem terjedhet ki a kiváltó ok kezelésére, ezért a jelen összefoglaló másik célja azon gyógyszeres és invazív terápiás beavatkozások összefoglalása, melyek a felső húgyutak védelmét szolgálják az alacsony hólyagnyomás fenntartása révén. Orv Hetil. 2021; 162(4): 135–143. Summary. Storage and urination are the main functions of the lower urinary tract and its lesions lead to the so-called lower urinary tract syndrome causing either urinary incontinence or retention. In untreated cases, the upper urinary tract becomes injured via a vesicoureteral reflux resulting from increased bladder pressure and resultant dilations of the ureter and the renal pelvis which predispose to infection and stone formation. Lower urinary tract storage/urination disorders can be classified as stress incontinence, hyperactive bladder (wet/dry) and neurogenic bladder. Neurogenic bladder which is the subject of this review, is a collective term that encompasses all urinary storage and emptying disorders which develop on the basis of neurological diseases. Being not only the bladder, but also the sphincter and posterior urethra (generally termed as the “bladder outlet”) affected, nowadays this condition is referred to as “neurogenic lower urinary tract dysfunction”. A wide range of neurological dysfunctions could contribute to the development of this condition, ranging from local dysfunction (autonomic dysreflexia) or local nerve injury to upper/lower motoneuron injury or central degenerative processes. Regardless of the diverse etiology, the clinical symptoms eventually manifest in two major forms, i.e., overacting (automatic bladder with increased detrusor contractility) and underactive bladder. Considering the severity of complication occurring in the upper urinary tract in response to the pathophysiological changes in the lower urinary tract, one of the aims of this paper was to present an algorithm aiming to build up a state of the art diagnosis of the disease based on current international literature data. Since treatment of the neurogenic bladder usually can not target elimination of the underlying cause, the other goal of the present paper is to summarize the pharmacological treatment regimen and invasive therapeutic interventions that protect the upper urinary tract by maintaining low pressure values in the bladder. Orv Hetil. 2021; 162(4): 135–143.

Neurogenic lower urinary tract dysfunction in the early disease phase of paediatric multiple sclerosis

2016 ◽  
Vol 22 (11) ◽  
pp. 1490-1494 ◽  
Author(s):  
Jeroen R Scheepe ◽  
Yu Yi M Wong ◽  
E Daniëlle van Pelt ◽  
Immy A Ketelslegers ◽  
Coriene E Catsman-Berrevoets ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Early Disease ◽  
High Prevalence ◽  
Potential Damage ◽  
Urinary Problems ◽  
Lower Urinary

Neurogenic lower urinary tract dysfunction (LUTD) in multiple sclerosis (MS) is highly prevalent in adults, but has not previously been described in paediatric MS. A total of 24 consecutive children with newly diagnosed MS were prospectively assessed for bladder and bowel problems early after diagnosis. Five of 24 children (21%) showed LUTD during assessment. One of these patients did not report voiding complaints. This high prevalence of LUTD indicates that all recently diagnosed patients with paediatric MS should be evaluated early in their disease and treated for urinary problems in order to prevent potential damage to the upper urinary tract.

HPSE2 Mutations in Urofacial Syndrome, Non-Neurogenic Neurogenic Bladder and Lower Urinary Tract Dysfunction

Nephron ◽  
2015 ◽  
Vol 130 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Burcu Bulum ◽  
Z. Birsin �z�akar ◽  
Duygu Duman ◽  
Filiz Basak Cengiz ◽  
Asli Kavaz ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Lower Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Urofacial Syndrome ◽  
Lower Urinary

scholarly journals Role of Uroflowmetry in Children with Ano-Rectal Malformation in Anticipating Upper Urinary Tract Damage

2017 ◽  
Vol 53 (02) ◽  
pp. 090-096
Author(s):  
Rahul Saxena ◽  
Arvind Sinha ◽  
Manish Pathak ◽  
Avinash S Jadhav ◽  
Ankur Bansal
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Asymptomatic Children ◽  
Determine Role ◽  
Urinary Tract Symptoms ◽  
Tract Damage ◽  
Lower Urinary

ABSTRACT Background: The lower urinary tract dysfunction (LUTD) has high incidence in children with anorectal malformation (ARM) which if left untreated leads to upper tract damage. Aim: To determine role of uroflowmetry in early diagnosis of LUTD in children with ARM. Methods: This prospective study included twenty consecutive patients of ARM and every patient underwent uroflowmetry at-least 6 weeks after definitive procedure. Results: The mean age of patients was 3.015±0.86 years. Of the twenty patients, there were 12 (60%) males and 8 (40%) females; 11 (55%) were high ARM, 4 (20%) were intermediate and 5(25%) were low ARM. Lower urinary tract symptoms (LUTS) was present in 8/20 (40%) patients but uroflowmetric abnormalities were present in 11/20 (55%) patients. Forty five percent (5/11) patients with abnormal uroflowmetry were asymptomatic and 25% (2/8) symptomatic patients had normal uroflowmetry. The incidence of uroflowmetric abnormalities was significantly higher in patients with spinal anomalies (p=0.03; χ2=4.1) and those with high ARM (p=0.004; χ2=8.1). Conclusion: Uroflowmetry is a noninvasive method that may help in early detection of neurovesical dysfunction in asymptomatic children and subsequent cystometric analysis in patients with uroflowmetric abnormalities can be done for early definitive diagnosis and prevention of upper urinary tract damage.

scholarly journals Voiding dysfunction and urodynamic abnormalities in elderly patients

2004 ◽  
Vol 59 (4) ◽  
pp. 206-215 ◽  
Author(s):  
Cristiano M. Gomes ◽  
Sami Arap ◽  
Flávio E. Trigo-Rocha
Keyword(s):  
Urinary Tract ◽  
Elderly Patients ◽  
Lower Urinary Tract ◽  
Outlet Obstruction ◽  
The Elderly ◽  
Lower Urinary Tract Dysfunction ◽  
Clinical Aspects ◽  
Functional Impairments ◽  
Detrusor Contractility ◽  
Lower Urinary

Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in elderly men and women. With the progressive aging of the population, it is important to understand common micturitional disorders that may occur in this population. Most urinary problems in the elderly are multifactorial in origin, demanding a comprehensive assessment of the lower urinary tract organs, functional impairments, and concurrent medical diseases. Urodynamics is a highly valuable tool in the investigation of elderly patients with lower urinary tract symptoms. Urodynamic tests are not always necessary, being indicated after excluding potentially reversible conditions outside the urinary tract that may be causing or contributing to the symptoms. Although urodynamic tests may reveal common diagnoses such as bladder outlet obstruction and stress urinary incontinence in the elderly population, findings such as detrusor overactivity and impaired detrusor contractility are common and have important prognostic and therapeutic implications. The purpose of this article is to describe common urologic problems in the elderly and review the indications for and clinical aspects of urodynamic studies in these conditions.

Intrathecal Opioids and Lower Urinary Tract Function

2004 ◽  
Vol 100 (6) ◽  
pp. 1497-1503 ◽  
Author(s):  
Peter W. Kuipers ◽  
Ed T. Kamphuis ◽  
Ger E. van Venrooij ◽  
John P. van Roy ◽  
Traian I. Ionescu ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Intrathecal Administration ◽  
Lower Urinary Tract Dysfunction ◽  
Flow Measurements ◽  
Detrusor Contractility ◽  
Lower Urinary Tract Function ◽  
Tract Function ◽  
Dose Dependent ◽  
Lower Urinary

Background Intrathecal administration of opioids may cause lower urinary tract dysfunction. In this study, the authors compared the effects of morphine and sufentanil administered intrathecally in a randomized double-blind fashion (two doses each) on lower urinary tract function in healthy male volunteers. Methods Urodynamic evaluation was performed before and every hour after drug administration up to complete recovery of lower urinary tract function using pressure and flow measurements recorded from catheters in the bladder and rectum. Sense of urge and urinary flow rates were assessed every hour by filling the bladder with its cystometric capacity and asking the patient to void. Full recovery was defined as a residual volume of less than 10% of bladder capacity and a maximum flow rate within 10% of the initial value. Results Intrathecal administration of both opioids caused dose-dependent suppression of detrusor contractility and decreased sensation of urge. Mean times to recovery of normal lower urinary tract function were 5 and 8 h after 10 or 30 microg sufentanil and 14 and 20 h after 0.1 or 0.3 mg morphine, respectively. This recovery profile can be explained by the spinal pharmacokinetics of both opioids. Conclusions Intrathecal opioids decrease bladder function by causing dose-dependent suppression of detrusor contractility and decreased sensation of urge. Recovery of normal lower urinary tract function is significantly faster after intrathecal sufentanil than after morphine, and the recovery time is clearly dose dependent.

scholarly journals Neurogenic Bladder: Epidemiology, Diagnosis, and Management

2020 ◽  
Vol 40 (05) ◽  
pp. 569-579
Author(s):  
Jalesh N. Panicker
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Renal Ultrasound ◽  
Preliminary Evaluation ◽  
Cord Injury ◽  
Tailored Approach ◽  
Tract Damage ◽  
Lower Urinary

AbstractLower urinary tract dysfunction is a common sequel of neurological disease resulting in symptoms that significantly impacts quality of life. The site of the neurological lesion and its nature influence the pattern of dysfunction. The risk for developing upper urinary tract damage and renal failure is considerably lower in patients with slowly progressive nontraumatic neurological disorders, compared with those with spinal cord injury or spina bifida. This acknowledged difference in morbidity is considered when developing appropriate management algorithms. The preliminary evaluation consists of history taking, and a bladder diary and may be supplemented by tests such as uroflowmetry, post-void residual measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the clinical indications. Incomplete bladder emptying is most often managed by intermittent catheterization, and storage dysfunction is managed by antimuscarinic medications. Intra-detrusor injections of onabotulinumtoxinA have revolutionized the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. In select patients, reconstructive urological surgery may become necessary. An individualized, patient-tailored approach is required for the management of lower urinary tract dysfunction in this special population.

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