What is a neurological bladder
Neurogenic detrusor overactivity
Neurogenic bladder dysfunction
Neurogenic detrusor overactivity is the result of damage to the nervous system through illness, accidents or congenital malformations. Accidents with traumatic paraplegia are the main cause of the acquired disorders.
Damage to the nervous system disrupts the interaction of all the nerves and organs involved in urine storage and emptying, and micturition cannot be controlled. For the clinical picture of neurogenic detrusor overactivity, the point at which the damage to the nervous system took place is decisive.
Diagnosis and therapy of neurogenic detrusor overactivity
Since the neurogenic detrusor overactivity can lead to kidney damage, early diagnosis and subsequent therapy are imperative.
When diagnosing neurogenic detrusor overactivity, the type and severity of the malfunction of the bladder and sphincter, the function of the kidneys and the underlying neurological disease are examined. The synopsis of the knowledge gained in this way forms the basis for the therapeutic options to be worked out together with the patient.
Since damage to the central and peripheral nervous system is currently not curable, only the effects of this on the lower urinary tract can be treated. The protection of the kidneys, continence and complete emptying of the bladder are therefore the goals of therapy for neurogenic detrusor overactivity.
The current standard therapy for neurogenic detrusor overactivity is the controlled emptying of the bladder by intermittent self-catheterization in combination with anticholinergic substances that can be administered as tablets or as instillation (introduction) into the. Due to the drug treatment, the bladder pressure is lowered, thus protecting the kidneys and helping the patient to become continence. In the course of drug therapy, however, things such as visual disturbances and dry mouth can occur.
With intermittent self-catheterization, the patient inserts a catheter four to five times a day for one-time emptying of the bladder.
Minimally invasive therapy
An alternative to conservative therapy for neurogenic detrusor overactivity is the injection of botulinum toxin A into the bladder muscle. This prevents the uncontrolled contraction of the bladder muscle by blocking the receptors. The bladder is able to hold urine again. The effects of a single injection of the toxin last an average of five to seven months. In most cases, patients also have to perform intermittent self-catheterization, as the paralysis of the bladder muscle leads to high residual urine volumes. Botulinum toxin A is currently not yet approved for use in the urinary bladder.
If the conservative and minimally invasive measures for treating neurogenic detrusor overactivity are unsuccessful, surgery may be necessary. This includes, among other things, the urinary drainage through the abdominal wall. This achieves both continence and protection of the upper urinary tract. In addition, methods of bladder expansion (augmentation) can also be used.
Since all surgical procedures involve an increased risk of complications for the patient, conservative therapy for neurogenic detrusor overactivity should first be sought. In some cases, however, one surgical measure is the only option so far.
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