source: here
Having lived with multiple sclerosis for a number of years, I’ve now been diagnosed with something called neurogenic bladder. Are the two conditions related?
Neurogenic bladder is the loss of normal bladder function caused by damage to part of the nervous system. Disorders of the central nervous system, such as Alzheimer’s disease, spina bifida, brain or spinal cord injury, multiple sclerosis, Parkinson’s disease and stroke can all cause neurogenic bladder.
Peripheral diabetic neuropathy nerve damage due to pelvic surgery, slipped disc and vitamin B12 deficiency may also cause the condition.
What are the symptoms?
The particular symptoms experienced will very much depend on the underlying neurological disorder, and can include an overactive or underactive bladder. Overactive bladder tends to produce frequent passing of very small amounts of urine, problems emptying the bladder completely and loss of bladder control.
Underactive bladder can result in the bladder becoming too full, leaking of urine and urinary retention. It can also cause difficulties starting to urinate, emptying all the urine from the bladder or recognising when the bladder is full.
All bladder problems can lead to the development of urinary tract infections.
Do I just have to live with it or can neurogenic bladder be treated?
Medications are available to help manage symptoms. These include drugs that relax the bladder in cases of overactive bladder or medicines that make certain nerves more active for underactive bladder.
Antibiotics are required where bladder problems lead to infections. A referral to a chartered physiotherapist with experience in the area of treating continence problems may help. They will be able to teach you special exercises (Kegel exercises) and provide other treatments to help strengthen your pelvic-floor muscles.
In certain conditions, including multiple sclerosis, there may be a need to use a urinary catheter. This is a thin tube that is inserted into the bladder.
It may be in place all the time (an indwelling catheter) or may need to be placed in the bladder four to six times a day to keep the bladder from becoming too full (intermittent catheterisation).
Surgery for neurogenic bladder may be recommended in some cases. It is important to learn to recognise the symptoms of urinary tract infection, such as a burning sensation when you urinate, high temperature, low back pain and an increased frequency of urination.
If you suspect you have developed a urinary tract infection, see your doctor, as antibiotics will be needed to clear the infection.
Last Updated: July 27, 2020 by uabadmin
Different evolution of voiding function in underactive bladders with and without detrusor overactivity.
Different evolution of voiding function in underactive bladders with and without detrusor overactivity.: “
Different evolution of voiding function in underactive bladders with and without detrusor overactivity.
J Urol. 2010 Jan;183(1):229-33
Authors: Cucchi A, Quaglini S, Rovereto B
PURPOSE: We assessed bladder voiding function in patients with idiopathic detrusor underactivity with and without detrusor overactivity for a different evolution in time. MATERIALS AND METHODS: We retrospectively analyzed clinical and urodynamic findings in 36 consecutive middle-aged men with idiopathic detrusor underactivity who were referred during 1989 to 2003 for voiding and storage lower urinary tract symptoms. After initial testing at time 1 urodynamics were repeated due to worse lower urinary tract symptoms severity at a median of 45 months (time 2). A total of 17 patients with voiding urgency showed urodynamic detrusor overactivity at times 1 and 2 (group 1) and 19 with no urgency (group 2) never had detrusor overactivity. As controls (group 3) we used 30 age matched, urodynamically normal men. Nonparametric statistics were used for data analysis. RESULTS: Compared with controls at time 1 groups 1 and 2 had lower bladder emptying efficiency and bladder contractility (contraction strength, velocity and energy reserve) with relatively higher contraction velocity and energy reserve in group 1 than in group 2. Compared with time 1 at time 2 the 2 detrusor underactivity groups showed an increased International Prostate Symptom Score (more increased in group 1), and decreased bladder contractility and emptying efficiency (less decreased in group 1). CONCLUSIONS: A likely explanation for our findings is that by causing relatively more rapid (less slow) detrusor contractions detrusor overactivity partly decreased the time needed and, thus, the total energy expended by underactive bladders for mounting micturition contractions. This compensatory efficiency would account for the relatively better evolution of bladder voiding function with time.
PMID: 19913829 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?
Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?: “
Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?
Ann Indian Acad Neurol. 2009 Apr;12(2):104-7
Authors: Gupta A, Taly AB, Srivastava A, Thyloth M
OBJECTIVE: Assessment of bladder by urodynamic study (UDS) in patients with urinary incontinence following stroke, and correlation with site of lesion. STUDY DESIGN AND SETTING: Retrospective cross-sectional study in the neurological rehabilitation unit of a tertiary care institute. MATERIALS AND METHODS: Forty patients (22 males) with arterial or venous, ischemic or hemorrhagic stroke, with urinary incontinence in the acute phase following the event, underwent UDS. Seventeen patients had right hemiplegia, 18 had left hemiplegia, and five had posterior circulation stroke with brainstem/cerebellar features. Bladder type was correlated with age, side, and site of lesion. RESULTS: The mean age was 46.80 +/- 16.65 years (range: 18-80 years). Thirty-six patients had arterial stroke and four had cortical venous thrombosis. UDS was performed after a mean of 28.32 +/- 10.27 days (range: 8-53 days) after the stroke. All but one patient had neurogenic bladder dysfunction, with 36 patients (90%) having overactive detrusor (OD) and three having underactive/areflexic detrusor. Among the 36 patients with OD, 25 patients (62.5%) had OD without detrusor-sphincter dyssynergy (DSD) and 11 (27.5%) had OD with DSD. Bladder management was advised based on the UDS findings. No significant correlation (P > 0.05) was found between type of bladder and age or side and site of lesion. CONCLUSIONS: UDS is a useful tool to assess and manage the bladder following stroke with urinary incontinence. In this study, no significant correlation was found between UDS findings and site of lesion.
PMID: 20142855 [PubMed]
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Last Updated: July 27, 2020 by uabadmin
Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy.
Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy.: “
Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy.
Urol Int. 1991;47 Suppl 1:67-8
Authors: Komine S, Yoshida H, Fujiyama C, Masaki Z
Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy (HAM) was studied. All the patients were diagnosed as having HAM by neurologists. We have already reported on 16 consequent patients with HAM. Almost all of these patients had frequency, and many had urge incontinence of urine and difficulty on voiding. Urodynamic study revealed that their voiding symptoms seemed to be due to detrusor hyperactivity and detrusor-sphincter dyssynergia. However, we have recently treated 2 patients who had a different bladder function. They had both frequency and difficulty in voiding but without urgency. In the urodynamic study both patients did not have involuntary bladder contraction during the filling phase and could not void voluntarily. The reason why these 2 patients had an underactive detrusor is unclear. The fact that the average duration of HAM in the 16 patients previously mentioned was longer than that of the latter 2 patients may suggest that overactivity of the bladder is not prominent in the early phase of this disease.
PMID: 1949381 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
[Neurogenic bladder in patients with lumbar vertebral disorders]
[Neurogenic bladder in patients with lumbar vertebral disorders]: “
[Neurogenic bladder in patients with lumbar vertebral disorders]
Nippon Hinyokika Gakkai Zasshi. 1990 Sep;81(9):1322-9
Authors: Ando M, Nagamatsu H, Tanizawa A, Oshima H, Shinomiya K, Matsuoka T, Mizuo T, Ushiyama T
Bladder and urethral functions were evaluated urodynamically in 114 patients with lumbar disorders including prolapsed lumbar intervertebral disc (66 patients), lumbar canal stenosis (19 patients), lumbar spondylolysis and/or spondylolisthesis (21 patients), lumbar spondylosis deformans (5 patients) and ossification of the yellow ligament of the lumbar spine (3 patients). The patients consisted of 88 males and 26 females with an average age of 47 years (range 17 to 73 years). Symptomatic organic infravesical obstruction was excluded by physical and radiographic examination. Cystometry revealed preoperative neurogenic bladder in 23 patients (20%); normal detrusor with overactive sphincter in 2 (9%), underactive in 8 (36%), overactive in 5 (23%) and equivocal in 7 (32%). One patient not receiving cystometry revealed abnormal uroflowmetry with 140 ml residual urine. Twenty of them underwent electromyographic examination of the external sphincter and 15 (75%) had an overactive sphincter. Nine (39%) of them complained no urological symptoms. Neurogenic bladder seemed to highly associate in those having abnormal tendon reflex in the lower extremities, decreased bulbocavernosus reflex and sensory disturbance in the perineal area, but there was no statistical significance. Of twenty-three neurogenic bladder patients, eighteen underwent a lumbar vertebral operation and fifteen received postoperative urodynamic evaluation. Uroflowmetry was improved in more than half of the patients within 3 months after the operation and cystometry was normalized in 4 of 7 patients who underwent cystometry over 6 months after the operation. Preoperative overactive detrusor remained unchanged in two of three patients who underwent cystometry over 6 months after the operation.
PMID: 2232423 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Marion Kerr writes about Neurogenic Bladder
source: here
Having lived with multiple sclerosis for a number of years, I’ve now been diagnosed with something called neurogenic bladder. Are the two conditions related?
Neurogenic bladder is the loss of normal bladder function caused by damage to part of the nervous system. Disorders of the central nervous system, such as Alzheimer’s disease, spina bifida, brain or spinal cord injury, multiple sclerosis, Parkinson’s disease and stroke can all cause neurogenic bladder.
Peripheral diabetic neuropathy nerve damage due to pelvic surgery, slipped disc and vitamin B12 deficiency may also cause the condition.
What are the symptoms?
The particular symptoms experienced will very much depend on the underlying neurological disorder, and can include an overactive or underactive bladder. Overactive bladder tends to produce frequent passing of very small amounts of urine, problems emptying the bladder completely and loss of bladder control.
Underactive bladder can result in the bladder becoming too full, leaking of urine and urinary retention. It can also cause difficulties starting to urinate, emptying all the urine from the bladder or recognising when the bladder is full.
All bladder problems can lead to the development of urinary tract infections.
Do I just have to live with it or can neurogenic bladder be treated?
Medications are available to help manage symptoms. These include drugs that relax the bladder in cases of overactive bladder or medicines that make certain nerves more active for underactive bladder.
Antibiotics are required where bladder problems lead to infections. A referral to a chartered physiotherapist with experience in the area of treating continence problems may help. They will be able to teach you special exercises (Kegel exercises) and provide other treatments to help strengthen your pelvic-floor muscles.
In certain conditions, including multiple sclerosis, there may be a need to use a urinary catheter. This is a thin tube that is inserted into the bladder.
It may be in place all the time (an indwelling catheter) or may need to be placed in the bladder four to six times a day to keep the bladder from becoming too full (intermittent catheterisation).
Surgery for neurogenic bladder may be recommended in some cases. It is important to learn to recognise the symptoms of urinary tract infection, such as a burning sensation when you urinate, high temperature, low back pain and an increased frequency of urination.
If you suspect you have developed a urinary tract infection, see your doctor, as antibiotics will be needed to clear the infection.
Last Updated: July 27, 2020 by uabadmin
The Unusual History and the Urological Applications of Botulinum Neurotoxin.
The Unusual History and the Urological Applications of Botulinum Neurotoxin.: “
The Unusual History and the Urological Applications of Botulinum Neurotoxin.
Urol Int. 2010 Jul 27;
Authors: Hanchanale VS, Rao AR, Martin FL, Matanhelia SS
Introduction: Botulinum neurotoxin (BoNT) is probably the most potent biological toxin that can affect humans. Since its discovery by Justinus Kerner, BoNT has seen use in a wide range of cosmetic and non-cosmetic conditions such as cervical dystonia, cerebral palsy, migraines and hyperhidrosis. We tried to trace its history from its inception to its recent urological applications. Materials and Methods: Historical articles about botulinum toxin were reviewed and a Medline search was performed for its urological utility. We hereby present a brief review of historical aspects of BoNT and its applications in urology. Results: In 1793, the first known outbreak of botulism occurred due to ‘spoiled’ sausage in Wildebad, Germany. The German physician and poet Justinus Kerner published the first accurate description of the clinical symptoms of botulism (sausage poison). He was also the first to mention its potential therapeutic applications. In urology, BoNT has been used in bladder and urethral lesions with varying degree of success. Recently, BoNT applications were explained for prostatic disorders. BoNT applications in urology are in the treatment of detrusor external sphincter dyssynergia, detrusor overactivity, detrusor underactivity, spastic conditions of the urethral sphincter, chronic prostate pain, interstitial cystitis, non-fibrotic bladder outflow obstruction (including benign prostatic hyperplasia) and acute urinary retention in women. Conclusion: Justinus Kerner is the godfather of botulism research. The role of BoNT in urology has evolved exponentially and it is widely used as an adjuvant in voiding dysfunction. In the future, its utility will broaden and guide the urologist in managing various urological disorders.
PMID: 20664247 [PubMed – as supplied by publisher]
“
Last Updated: July 27, 2020 by uabadmin
[Neurogenic bladder in patients with cervical cord compression disorders]
[Neurogenic bladder in patients with cervical cord compression disorders]: “
[Neurogenic bladder in patients with cervical cord compression disorders]
Nippon Hinyokika Gakkai Zasshi. 1990 Feb;81(2):243-50
Authors: Ando M
Bladder and urethral functions were evaluated urodynamically in 62 patients with cervical cord compression disorder caused by either ossification of the posterior longitudinal ligament of the cervical spine (32 patients), cervical spondylosis (14 patients), prolapsed cervical intervertebral disc (14 patients) or cervical spinal canal stenosis (2 patients). The patients included 46 males and 16 females with average age of 57 years (range 39 to 73 years). Symptomatic organic infravesical obstruction was excluded by physical and radiographic examination. Cystometry revealed preoperative neurogenic bladder in 22 patients (35%) including overactive detrusor in 10 patients (45%) and underactive in 6 (27%). Twenty-one of them underwent electromyographic examination of external sphincter and 14 (67%) had overactive sphincter. Bladder and urethral functions appeared to be impaired in association with myelopathy of the pyramidal and spinothalamic tract of the cervical cord, because of high incidence of neurogenic bladder associated with positive Babinski’s reflex and sensory disturbance at the perineal and lower extremity area. Furthermore, since many patients with deep sensory disturbance in the lower extremities had underactive detrusor, it appears likely that underactive detrusor was accompanied with myelopathy in the posterior funiculus of the cervical cord which mediates bladder proprioceptive sensation. Of twenty-two neurogenic bladder patients, seventeen underwent a cervical bone operation and eleven received postoperative urodynamic evaluation. The average interval from the operation to urodynamic evaluation was 1.6 months (range 1.1 to 2.3 months). Over half of the patients were found to be improved urodynamically as well as neurologically.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID: 2325322 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Incomplete Bladder Emptying in Patients With Stroke: Is Detrusor External Sphincter Dyssynergia a Potential Cause?
Incomplete Bladder Emptying in Patients With Stroke: Is Detrusor External Sphincter Dyssynergia a Potential Cause?: “
Incomplete Bladder Emptying in Patients With Stroke: Is Detrusor External Sphincter Dyssynergia a Potential Cause?
Arch Phys Med Rehabil. 2010 Jul;91(7):1105-1109
Authors: Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou EC
Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou EC. Incomplete bladder emptying in patients with stroke: is detrusor external sphincter dyssynergia a potential cause? OBJECTIVES: To delineate the frequency, clinical risk factors, and urodynamic mechanisms of incomplete bladder emptying (IBE) among patients with recent stroke. DESIGN: Retrospective study. SETTING: Inpatient setting in the rehabilitation ward of a university hospital. PARTICIPANTS: All patients with acute stroke admitted for rehabilitation between January and December 2005, excluding those with a history of lower-urinary tract symptoms and urologic diseases. Eighty-two patients (42 women and 40 men; mean age, 65.5y) were included. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We measured postvoid residual (PVRs) by catheterization or by using an ultrasonic bladder scanner. Twenty-five patients (30.5%) had IBE with PVRs greater than 100mL on 2 consecutive days. Patients with IBE were evaluated by a urologist and subsequently underwent urodynamic studies. RESULTS: The presence of IBE was significantly associated with urinary tract infection (P<.001) and aphasia (P=.046). The presence of IBE was not related to sex, stroke location, nature of stroke (hemorrhagic or ischemic), history of diabetes mellitus, or previous stroke. Urodynamic studies done on 22 patients with IBE revealed acontractile detrusor in 8 patients (36%) and detrusor underactivity in 3 (14%). Eleven patients (50%) had detrusor-external sphincter dyssynergia (DESD) combined with normative detrusor function (5 patients) or detrusor hyperactivity (6 patients); all but 1 of these patients had a supratentorial lesion. The presence of DESD was associated with a longer onset-to-evaluation interval (P=.008) and spasticity of the stroke-affected lower limb (P=.002). Diabetes mellitus was associated with the presence of acontractile detrusor or detrusor underactivity (P=.03). CONCLUSIONS: IBE is common among patients with stroke and is caused by decreased detrusor contractility or DESD. Spasticity of the external urethral sphincter is a possible pathophysiologic mechanism of DESD.
PMID: 20599050 [PubMed – as supplied by publisher]
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Last Updated: July 27, 2020 by uabadmin
Functional assessment of the bladder.
Functional assessment of the bladder.: “
Functional assessment of the bladder.
Ciba Found Symp. 1990;151:139-47; discussion 147-55
Authors: Nordling J
The urinary bladder has two functions: to store and to empty. A frequency-volume chart completed by the patient provides useful information about voiding intervals, possible factors provocative for incontinence, functional bladder capacity and daily urine volume. Filling cystometry is used primarily to evaluate reflex function in the storage phase, giving information about the presence or absence of detrusor instability and (in combination with urethral EMG) about detrusor-sphincter coordination. Information is also obtained about bladder sensation, bladder capacity and bladder compliance. Detrusor function during emptying is closely related to outflow conditions and therefore demands simultaneous registration of detrusor pressure and urinary flow rate. An inverse relation exists between detrusor pressure and flow rate, which means that reduced flow rate causes increased detrusor pressure for the same detrusor power. Underactive detrusor function will result in low detrusor pressure and low flow rate. The finding of a non-contractile detrusor may indicate psychogenic inhibition or a neurogenic lesion. Sacral evoked potentials and denervation supersensitivity tests may help to distinguish between these conditions.
PMID: 2226057 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.
Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.: “
Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.
Int J Urol. 2010 May 17;
Authors: Kim TG, Yoo KH, Jeon SH, Lee HL, Chang SG
Objectives: To determine the effect of unilateral hemispheric lesion on voiding dysfunction by comparing urodynamic parameters in dominant, non-dominant and bilateral hemispheric stroke patients. Methods: We retrospectively reviewed the medical records of patients from a magnetic resonance imaging and urodynamic study. We identified 69 cases among 192 stroke patients who had undergone urodynamic study due to lower urinary tract symptoms from June 2003 to December 2008. Results: Among the analyzed variables in the urodynamic study, total bladder capacity, voided volume, postvoid residual urine volume, maximum flow rate, average flow rate, detrusor pressure at the maximum flow rate, and bladder compliance did not show statistically significant differences among dominant, non-dominant and bilateral hemispheric stroke patients groups (P > 0.05). The dominant hemispheric stroke group had detrusor overactivity in 64.2% of cases and detrusor underactivity in 35.8%; the non-dominant hemispheric stroke group had detrusor overactivity in 66.7% of cases and detrusor underactivity in 33.3%; and the bilateral stroke group had detrusor overactivity in 60.0% of cases and detrusor underactivity in 40.0% (P = 0.946). Conclusion: Urodynamic findings cannot be characterized by the laterality of the unilateral hemispheric ischemic lesion. There are no significant differences in lower urinary tract symptoms between dominant, non-dominant and bilateral hemispheric ischemic stroke patients.
PMID: 20482661 [PubMed – as supplied by publisher]
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