Ways of diagnosis and possible complications after innervation of the bladder. Disorder of innervation Disorder of peripheral innervation of the bladder

Functional disorders in neurological clinic pelvic organs (disorders of urination, defecation and genital organs) are quite common.

Urination is carried out by the coordinated activity of two muscle groups: m. detrusor urinae and m. sphincter urinae. Contraction of muscle fibers of the first group leads to wall compression bladder, to squeezing out its contents, which becomes possible with the simultaneous relaxation of the second muscle. This happens as a result of the interaction of the somatic and autonomic nervous systems.

The muscles that make up the internal sphincter of the bladder and m. detrusor vesicae, are composed of smooth muscle fibers that receive autonomic innervation. The external sphincter of the urethra is formed by striated muscle fibers and is innervated by somatic nerves.

In the act of voluntary urination, other striated muscles are also involved, in particular the muscles of the anterior abdominal wall, the diaphragm of the pelvic floor. The muscles of the abdominal wall and diaphragm, with their tension, cause a sharp increase in intra-abdominal pressure, which complements the function of m. detrusor vesicae.

The mechanism of regulation of the activity of individual muscle formations that provide the function of urination is rather complicated. On the one hand, at the level of the segmental apparatus of the spinal cord, there is a vegetative innervation of the smooth fibers of these muscles; on the other hand, in an adult, the segmental apparatus obeys the cerebral cortical zone, and this is an arbitrary component of urination regulation.

Schematically, the innervation of the bladder can be depicted as follows.

In the act of urination, 2 components can be distinguished: involuntary reflex and voluntary. Segmental reflex inflated consists of the following neurons (Fig. 85): afferent part - cells of the intervertebral node S I - S III dendrites end in the proprioceptors of the bladder wall, are part of the pelvic visceral nerves (nn. Splanchnici pelvini), the pelvic nerve - nn. pelvici (BNA), axons go to the posterior roots and spinal cord, contact the cells of the anterolateral part of the gray matter of the spinal cord segments S I - S III (the spinal center of the parasympathetic innervation of the bladder). The fibers of these neurons, together with the anterior roots, leave the spinal canal and, as part of the pelvic nerve (N. pelvicus), reach the bladder wall, where they are interrupted in pl cells. vesicalis. The postsynaptic fibers of these intramural parasympathetic nodes innervate the smooth muscles of m. detrusor vesicae and partly the internal sphincter. Impulses along this reflex arc lead to a contraction of m. detrusor vesicae and relaxation of the internal sphincter.

Sympathetic cells that innervate the bladder are located at the level of L I - L II segments of the spinal cord. The fibers of these sympathetic neurons, together with the anterior roots, leave the spinal canal, then separate in the form of a white connecting branch and pass without interruption through the lumbar nodes of the sympathetic trunk, as part of the mesenteric nerves, reach the inferior mesenteric node, where they switch to the next neuron. Postsynaptic fibers in the composition of n. hypogastricus go to the smooth muscles of the bladder.

Figure: 85. Innervation of the bladder and its sphincters (diagram):

1 - pyramidal cell of the cortex of the paracentral lobule; 2 - a cell of the nucleus of a thin beam; 3 - sympathetic cell of the lateral horn L I - II; 4 - a cell of the spinal cord; 5 - parasympathetic cell of the lateral horn S I - III; 6 - peripheral motor neuron; 7 - genital nerve; 8 - cystic plexus; 9 - external sphincter of the urinary bladder; 10 - internal sphincter of the urinary bladder; 11 - hypogastric nerve; 12 - detrusor of the bladder; 13 - lower mesenteric node; 14 - sympathetic trunk; 15 - cell of the optic hillock; 16 - sensitive cell of the paracentral lobule.

The role of efferent sympathetic fibers is limited to lumen regulation blood vessels bladder and innervation of the muscles of the cystic triangle, which prevents ejaculate from entering the bladder at the time of ejaculation.

Automatic emptying of the bladder is provided by two segmental reflex arcs (parasympathetic and somatic). Irritation from stretching its walls along the afferent fibers of the pelvic nerve is transmitted to the spinal cord to the parasympathetic cells of the sacral segments of the spinal cord, impulses along efferent fibers lead to a reduction in m. detrusor vesicae and relaxation of the internal sphincter. The opening of the internal sphincter and the flow of urine into the initial sections of the urethra include another reflex arc for the external (striated) sphincter, when relaxed, urine is released. This is how the bladder functions in newborns. Later, in connection with the maturation of the suprasegmental apparatus, conditioned reflexes are also developed, a sensation of the urge to urinate is formed. Usually, this urge appears when the intravesical pressure rises by 5 mm Hg. Art.

The arbitrary component of the act of urination includes the control of the external urethral sphincter and auxiliary muscles (abdominal muscles, diaphragm, pelvic diaphragm, etc.).

Sensory neurons are embedded in the intervertebral nodes S I - S III. Dendrites run as part of the pudendal nerve and end with receptors both in the bladder wall and in the sphincters. The axons, together with the posterior roots, reach the spinal cord and, as part of the posterior cords, rise to the medulla oblongata. Further, these paths follow to the gyrus fornicatus (sensory area of \u200b\u200burination). By associative fibers, impulses from this zone are transmitted to the central motor neurons located in the cortex of the paracentral lobe (the motor zone of the bladder is located near the foot zone). The axons of these cells as part of the pyramidal pathway reach the cells of the anterior horns of the sacral segments (S II - S IV). The fibers of peripheral motor neurons, together with the anterior roots, leave the spinal canal, in the cavity of the small pelvis they form the plexus and in the n. pudendus approach the external sphincter. With the contraction of this sphincter, it is possible to voluntarily retain urine in the bladder.

With a bilateral violation of the connections of the cerebral (cortical) zones of the bladder with its spinal centers (this happens with transverse lesions of the spinal cord at the level of the thoracic and cervical segments), a violation of the urinary function occurs. Such a patient does not feel any urge or the passage of urine (or a catheter) through the urethra and cannot voluntarily control urination. In case of an acute violation, first comes urinary retention(retentio urinae); the bladder fills with urine and stretches to a large size (its bottom can reach the navel and above); it can only be emptied with a catheter. Subsequently, in connection with an increase in the reflex excitability of the segmental apparatus of the spinal cord, urinary retention is replaced by periodic incontinence (incontinentio intermittens).

In milder cases, the urge to urinate is observed.

In violation of the segmental autonomic innervation of the bladder and sphincters, various urinary disorders occur. Retention of urine occurs when the parasympathetic innervation is disturbed m. detrusor vesicae of the bladder (segments of the spinal cord S I - S IV, n. pelvicus).

Denervation of the internal and external sphincters leads to true urinary incontinence(incontinentia vera). This occurs when the lumbar segments of the spinal cord and cauda equina roots are affected, n. hypogastricus and n. pudendus. In such cases, the patient cannot hold urine, it is excreted involuntarily, either periodically or continuously.

There is another type of urinary disorder - paradoxical urinary incontinence(ischuria paradoxa), when there are elements of urinary retention (the bladder is constantly overfilled, it does not empty voluntarily) and incontinence (urine flows out all the time drop by drop due to mechanical overstretching of the sphincter).

Normal bedwetting (enuresis)in children it occurs at the age of 4 - 5 years and occurs due to the automatic regulation of the urination function. Enuresis stops when the volume of the bladder is 300-350 ml and contains the urine formed during the night. In adults, nocturnal enuresis in the overwhelming majority of cases indicates a functional disease of the nervous system.

Urination is carried out in a coordinated activitym. sphincter pupillae and m. detrusor pupillae.

This happens when the somatic and autonomic nervous systems interact.

The bladder has dual autonomic (sympathetic and parasympathetic) innervation.

Spinal parasympathetic center located in the lateral horns of the spinal cord on the level of segments S 2 -S 4 (Onuf's core).From it, parasympathetic fibers run as part of the pelvic nerves and innervate the smooth muscles of the bladder, mainly the detrusor. Parasympathetic innervation contributes to the contraction of the detrusor and relaxation of the sphincter, which allows the emptying of the bladder.

Fibers carry out sympathetic innervation from the lateral horns of the spinal cord (segments L 1 -L 2), then they pass as part of the hypogastric nerves (nn. hypogastrici) to the internal sphincter of the bladder. Sympathetic stimulation leads to contraction cystic triangle muscleswhich prevents reflux of urine into the bladder when urinating.

The functioning of the bladder is provided by the spinal reflex: the contraction of the sphincter is accompanied by the relaxation of the detrusor - the bladder fills with urine. When it is full, the detrusor contracts and the sphincter relaxes, urine is excreted. According to this type, urination is carried out in children in the first years of life, when the act of urination is not consciously controlled, but is carried out by the mechanism of an unconditioned reflex.

In a healthy adult, urination is carried out according to the type of a conditioned reflex: a person can deliberately delay urination when an urge occurs and empty the bladder at will. Voluntary regulation is carried out with the participation of cortical sensory and motor zones. Supraspinal control mechanisms include bridge Center (Barington), part of reticular formation... The afferent part of this conditioned reflex begins with receptors that are located in the area of \u200b\u200bthe internal sphincter. Further, the signal through the spinal nodes, dorsal roots, dorsal cords, medulla oblongata, bridge, midbrain is sent to the sensory part of the cortex (girus fornicatus), from where, along the associative fibers, impulses enter the cortical motor urinary center, which is localized in the paracentral lobule (lobulus paracentralis).

The efferent part of the reflex as part of the cortical-spinal tract passes in the lateral and anterior cords of the spinal cord and ends in the spinal centers of urination (S 2 -S 4 segments), which have a bilateral cortical connection. Further, the fibers through the anterior roots, the genital plexus and the pudendal nerve (p. Pudendus) reach the external sphincter of the bladder. When the external sphincter contracts, the detrusor relaxes and the urge to urinate is inhibited. When urinating, not only the detrusor is strained, but also the muscles of the diaphragm, abdominal press, in turn, the internal and external sphincters relax.

Neurogenic bladder is a syndrome that combines urinary disorders that occur when the nerve pathways or centers that innervate the bladder and provide the function of voluntary urination are affected. With bilateral lesions of the cortex and its connections with the spinal (sacral) centers of urination, urinary disorders occur by the central type, which can be manifested by complete retention of urine (retention urinae), which occurs in the acute period of the disease (myelitis, spinal trauma, etc.). In this case, the reflex activity of the spinal cord is inhibited, spinal reflexes disappear, in particular, the reflex of emptying the bladder - the sphincter is in a state of contraction, the detrusor is relaxed and does not function. Urine expands the bladder to a large size. In such cases, bladder catheterization is necessary. In the future (after 1-3 weeks), the reflex excitability of the segmental apparatus of the spinal cord increases and urinary retention is replaced by urinary incontinence. Urine is excreted periodically in small portions as it accumulates in the bladder; that is, the bladder empties automatically, functions as an unconditioned (spinal) reflex: the accumulation of a certain amount of urine leads to relaxation of the sphincter and contraction of the detrusor. This urinary disturbance is called intermittent urinary incontinence (incontinention intermittens).

If the pathological process is localized in sacral segments of the spinal cord, cauda equina roots and peripheral nerves (n. hypogastricus, n. pudendus), i.e., the parasympathetic innervation of the bladder is disrupted, there are dysfunctions of the pelvic organs along peripheral type... In the acute period of the disease, as a result of paralysis of the detrusor and preservation of the elasticity of the bladder neck, complete urinary retention occurs, or paradoxical urinary retention (ishuria paradoxa) with the release of urine in drops with an overflowing bladder in case of urinary retention (due to mechanical overstretching of the bladder sphincter). Subsequently, the neck of the bladder loses its elasticity, and the sphincter in this case is open, denervation of the internal and external sphincters occurs, therefore, true urinary incontinence (incontinention vera) occurs with the release of urine as it enters the bladder.

Vegetative innervation of the rectum and its sphincters are carried out according to the type of innervation of the bladder. The difference is that there is no detrusor muscle in the rectum, and its role is played by the abdominal muscles.

An important link in the process of urination is the occurrence of the urge to defecate. The work of this mechanism is provided by the innervation of the bladder - the numerous nerve endings of the organ provide the signals necessary for the body in a timely manner. Disruption of the nervous system can lead to dysfunction of emptying. It is possible to understand the relationship of structures by considering the mechanism of urine excretion.

Urinary Algorithm

The average is 500 ml. Slightly more in men (up to 750 ml). In women, as a rule, it does not exceed the 550 ml mark. Continuous work of the kidneys ensures periodic filling of the organ with urine. Its ability to stretch the walls allows urine to fill the organ up to 150 ml without any discomfort. When the walls begin to stretch and the pressure on the organ grows (this usually happens when urine is formed with a volume of more than 150 ml), the person feels the urge to bowel movement.

The reaction to irritation occurs at a reflex level. At the point of contact between the urethra and the bladder, there is an internal sphincter, a little lower another - the external one. Normally, these muscles are compressed and prevent the flow of urine. When there is a desire to get rid of urine, the valves relax, which ensures the contraction of the muscles of the organ that stores urine. Thus, the bladder is emptied.

Bladder Innervation Model

The innervation of the bladder provides the urge to urinate.

The connection between the urinary organ and the central nervous system is ensured by the presence of sympathetic, parasympathetic, spinal nerves in it. Its walls are equipped with a large number receptor nerve endings, scattered neurons of the autonomic nervous system and nerve nodes. Their functionality is the basis for stable, controlled urination. Each type of fiber serves a specific purpose. Innervation disorders lead to various disorders.

Parasympathetic innervation

The parasympathetic center of the bladder is located in the sacral spinal cord. Preganglionic fibers originate from there. They take part in the innervation of the pelvic organs, in particular, they form the pelvic plexus. The fibers stimulate the ganglia located in the walls of the organ of the urinary system, after which it smooth muscle the sphincters are reduced, accordingly, the sphincters relax, the intestinal peristalsis increases. This ensures emptying.

Sympathetic innervation

The cells of the autonomic nervous system involved in urination are located in the intermediate lateral gray column lumbar spinal cord. Their main purpose is to stimulate the closure of the cervix, due to which fluid accumulates in the bladder. It is for this that sympathetic nerve endings are concentrated in large numbers in the bladder triangle and neck. These nerve fibers practically do not affect motor activity, i.e. the very process of urine release from the body.

The role of sensory nerves

Any deviation in the intended work of the bladder can cause a number of ailments.

The reaction to the stretching of the walls of the bladder, in other words, the emergence of the desire for a bowel movement, is possible thanks to the afferent fibers. They start in the proprioceptors and noniceptors of the organ wall. The signal along them goes to the spinal cord segments T10-L2 and S2-4 through the pelvic, pudendal and hypoastral nerves. So the brain receives an impulse to empty the bladder.

Violation of the nervous regulation of urination

Violation of the innervation of the bladder is possible in 3 variants:

1. Hyperreflex bladder - urine stops accumulating and is immediately released, and therefore the urge to go to the toilet is frequent, and the volume of secreted fluid is very small. The disease is a consequence of damage to the central nervous system.
2. Hyporeflex bladder. Urine accumulates in large quantities, but its exit from the body is difficult. The bladder is significantly overfilled (up to one and a half liters of fluid can be collected in it), inflammatory and infectious processes in the kidneys are possible against the background of the disease. Hyporeflexia is defined by lesions of the sacral region of the brain.
3. Areflex bladder, in which the patient does not affect urination. It occurs by itself at the moment of maximum filling of the bubble.

A human brain disorder leads to bladder disease.

Such deviations are determined by various reasons, among which the most common are: craniocerebral trauma, cardiovascular diseases, brain tumors, multiple sclerosis... It is quite problematic to identify pathology based only on external symptoms. The form of the disease directly depends on the fragment of the brain that has undergone negative changes. The term "neurogenic bladder" has been coined in medicine to denote dysfunction of the urine accumulator due to nervous disorders. Different kinds defeats nerve fibers interfere with the excretion of urine from the body in different ways. The main ones are discussed below.

Brain lesions that disrupt innervation

Multiple sclerosis affects the work of the lateral and posterior pillars cervical spinal cord. In more than half of patients, involuntary urination is observed. Symptoms develop gradually. Sequestration intervertebral hernia at the initial stage, it causes a delay in urine output and difficulty in emptying. This is followed by symptoms of irritation.

Supraspinal lesions of the motor systems of the brain disable the urinary reflex itself. Symptoms include urinary incontinence, frequent urge, and nocturnal emptying. However, due to the preservation of the coordination of the work of the basic muscles of the bladder, the necessary level of pressure remains in it, which excludes the occurrence of urological ailments.

Neuropathy affects different parts of the nervous system, which leads to corresponding symptoms.

Peripheral paralysis also blocks reflex muscle contractions, causing the inability to independently relax the lower sphincter. Diabetic neuropathy causes disorders in the work of the detrusor of the bladder. Stenosis of the lumbar spine affects the urinary system according to the type and level of the destructive process. With cauda equina syndrome, incontinence due to overflow of a hollow muscular organ is possible, as well as a delay in urine excretion. Latent spinal dysraphism causes impaired reflexion of the bladder, in which conscious bowel movement is impossible. The process occurs independently at the time of maximum filling of the organ with urine.

The normal functioning of the bladder is regulated by a large number of plexuses at several levels. From congenital defects of the terminal spine and spinal cord to dysfunction nervous regulation sphincter - all these disorders can provoke the appearance of symptoms of a neurogenic bladder. These disorders can be the consequences of trauma and can be explained by other pathological processes of the brain, such as:

• Multiple sclerosis.
• Stroke.
• Encephalopathy.
• Alzheimer's disease.
• Parkinsonism.

Spinal cord lesions such as spondyloarthrosis, osteochondrosis, Schmorl's hernia, and trauma can also cause the development of a neurogenic bladder.

All types of violations have different causes. Most common: traumatic brain injury. cardiovascular diseases. tumors.

1. Cauda equina syndrome... Cause incontinence due to overflow of the urinary organ or suspension of excretion.
2. Diabetic neuropathy... It causes dysfunction of urine pushing out of the organ cavity. A narrowing (stenosis) occurs in the lumbar spine. The urinary system is disturbed.
3. Peripheral paralysis... Muscles cannot reflexively contract. The lower sphincter does not relax on its own.
4. Supraspinal disorders of the motor systems of the brain... The reflex function of urination is affected. Enuresis develops, increased urge even at night. The functionality of the basic muscles is preserved, the pressure is normal, there is no threat of urological diseases.
5. Multiple sclerosis - disrupts the functions of the lateral, posterior columns of the cervical spinal cord, which leads to reflexity. Symptoms develop gradually.

Classification

The connection between the urinary system and the central nervous system is carried out through parasympathetic, sympathetic, sensitive fibers. The slightest interruption in these areas leads to various disorders.

The parasympathetic center (excitatory fibers), located in the sacral spinal cord, is involved in the innervation of the pelvic organs. Responsible for relaxing the sphincter muscles, urine secretion.

The sympathetic center (vegetative), located in the intermediate lateral column of the lumbar spinal cord, stimulates cervical closure and urine retention in the bladder cavity.

The sensory nerves located in the posterior part of the urethral canal stretch the walls of the bladder and are responsible for the appearance of a reflex to emptying its cavity.

Distortion of the nervous regulation of urination leads to disruptions in the innervation of the organ.

Diseases provoked by the innervation of the organ in a filled and empty state of urine

The excess innervation leads to a neurogenic bladder. This ailment indicates the beginning of the incorrect work of the urinary canals. Problems urinary tract can be obtained throughout life or be a congenital disorder associated with nerves.

The connection between the bladder and the nervous system is very important for full life human. When a disease occurs, the patient's urinary canals atrophy, or they work too actively. Such disorders can manifest themselves with injuries or concurrent diseases (pathologies anterior section central nervous system, multiple sclerosis, stroke, parkinsonism, Alzheimer's disease, spinal cord injury). The patient completely loses control over the process of urine excretion from the body.

In turn, the neurogenicity of a muscular organ is subdivided into hyperactive and hypoactive types of disease development.

Violation of the innervation of the bladder in children

According to statistics, neurogenic bladder 10% of children suffer. This disease does not pose a threat to the child's life, and nevertheless it unpleasantly complicates the socialization of the baby: complexes arise, the quality of life is disturbed.

It is known that infants and children under two or three years old are not able to control the act of urination. However, when the sphincter control develops sufficiently, which is carried out with the help of the brain and spinal cord, the child asks for a potty, and then learns to go to the toilet on his own. If a child of three years and older is not able to control the process of urination, this indicates violations:

• pathologies of the central nervous system;
• neoplasms in the spine (malignant or benign);
• spinal hernia;
• encephalitis;
• do not lie;
• pathologies in the development of the sacrum and coccyx;
• violation of the autonomic nervous system;
• hypothalamic-pituitary insufficiency.

Usually, children suffering from a neurogenic bladder are prescribed therapy only after a complete examination of the child's body for possible pathologies in development. The complex of analyzes in children is no different from adults. This also includes general analysis blood, blood biochemistry, ultrasound, etc.

During treatment, excessive physical and emotional stress is contraindicated in children, hypothermia should not be allowed. Parents should be sympathetic to the baby's health problems, and should not swear for wet clothes or bed.

Signs and symptoms

Let's consider each deviation in order. Thus, a hyperreflex bladder is characterized by a constant urge to empty. This is because the impulse enters the spinal cord too quickly when the bladder is only half full. At the same time, very little fluid is released with each urination. The cause of the hyperreflex bladder may be a malfunction of the central nervous system (central nervous system).

A hyporeflex bladder is characterized by excessive fluid filling of the bladder as a result of inability to empty. In this case, the bladder does not contract. This is due to disturbances in the functioning of the sacral part of the spinal cord, because it is known that the spine affects the bladder (where the spinal cord is located in humans).

If the patient has an areflex bladder, this means that his brain is unable to control the process of urination. As a result, a person experiences great stress, because when the bladder fills, urine can begin to flow at the most inopportune moment.

The main causes of impaired urination or neurogenic bladder:

• encephalitis;
• tuberculomas;
• cholesteatoma;
• post-vaccination neuritis;
• diabetic neuritis;
• demyelinating diseases;
• nervous system injury;
• spinal cord pathology;
• pathology of the development of the central nervous system.

Signs and symptoms

In the presence of neurogenic dysfunction of the bladder, the ability to arbitrarily control the process of urination is lost.

The manifestations of a neurogenic bladder are of 2 types: hypertensive or hyperactive type, hypoactive (hypotonic) type.

Hypertensive type of neurogenic bladder

This type appears when the function of the part of the nervous system, which is located above the bridge of the brain, is impaired. At the same time, the activity and strength of the muscles of the urinary system becomes much greater. This is called detrusor hyperreflexia. With this type of disturbance of the innervation of the bladder, the process of urination can begin at any time, and often it occurs in an inconvenient place for a person, which leads to serious social and psychological problems.

In the presence of an overactive detrusor, the possibility of urine accumulation in the bladder is excluded, so people feel the need to go to the toilet very often. Patients with a hypertensive type of neurogenic bladder feel the following symptoms:

• Stranguria is pain in the urethra.
• Nocturia is frequent urination at night.
• Urgent urinary incontinence - rapid flow with strong urge.
• Strong tension of the pelvic floor muscles, which sometimes provokes a return direction of urine flow through the ureter.
• Frequent urge to urinate with a small amount of urine.

Hypoactive type of neurogenic bladder

The hypotonic type develops when a part of the brain is damaged below the bridge of the brain, most often it is a lesion in the sacral region. For such defects of the nervous system, insufficient contractions of the muscles of the lower urinary tract or a complete absence of contractions, which is called detrusor areflexia, are inherent.

With a hypotonic neurogenic bladder, physiologically normal urination is absent, even with a sufficient amount of urine in the bladder. People feel these symptoms:

• Feeling of insufficient bladder emptying that ends with a feeling of fullness.
• No urge to urinate.
• Very sluggish urine stream.
• Pain along the urethra.
• Incontinence of the bladder sphincter.

Disruption of innervation at any level can cause trophic disorders.

After collecting a detailed history, it is important to pass urine and blood tests to rule out the inflammatory nature of the disease. After all, the symptoms are often inflammatory processes very similar to the manifestation of a neurogenic bladder.

It is also worth examining the patient for anatomical anomalies in the structure of the urinary tract. For this, X-rays, urethrocystography, ultrasound, cystoscopy, MRI, pyelography and urography are performed. The most complete and clear picture is given by ultrasound.

After all the reasons have been ruled out, neurological examinations are worthwhile. For this purpose, EEG, CT, MRI are performed and various techniques are used.

A neurogenic bladder is treatable. To do this, use anticholinergics, adrenergic blockers, means to improve blood supply, and, if necessary, antibiotics. Physiotherapy exercises, rest and balanced nutrition will help to overcome the process faster.

To make an accurate diagnosis, the patient needs to consult a urologist and neurologist. The doctor will interview the patient, suggest the following methods:

• For several days, keep a log of time, volume of fluid drunk and urination.
• Hand over bacterial culture, OAM for infections.
• Get an X-ray with contrast agent, MRI, ultrasound to exclude tumors, inflammatory processes.
• To exclude pathological changes in the brain, spinal cord - CT, MRI.
• Additionally - uroflowmetry and cystoscopy.

If this diagnosis does not allow determining the cause, the diagnosis is made - neurogenic bladder of indeterminate origin.

In case of any violations of the urinary function in the body, you should immediately consult a urologist. After taking the history, the doctor may send you for the following tests:

1. x-ray of the spine and skull.
2. x-ray abdominal cavity.
3. MRI (magnetic resonance imaging).
4. Ultrasound of the kidneys and bladder.
5. UAC - general blood analysis.
6. blood seeding tank.
7. uroflowmetry.
8. cytoscopy.

X-rays of the spine and skull will reveal abnormalities in the patient's brain and spinal cord.

An abdominal X-ray is able to diagnose pathologies of the kidneys, bladder. A significant advantage of MRI compared to X-ray is the ability to see human organs in 3D, which will allow the doctor to diagnose the cause of the patient's disease with high accuracy.

Ultrasound of the kidneys and bladder will help to identify various pathologies and neoplasms in the kidneys and bladder, for example, stones, polyps.

A general blood test is an obligatory component of a complex of analyzes in the diagnosis of any disease. This study is able to identify the quantitative components of blood ( blood cells): leukocytes, erythrocytes, platelets. Any deviations from the norm in their composition will indicate the development of the disease.

A blood culture tank will help to identify the presence of bacteria in the patient's blood, to identify their sensitivity to various kinds of antibiotics.

Uroflowmetry is a procedure through which you can find out the basic properties of a patient's urine. This procedure will help to identify: the rate of urine flow, its duration, amount.

Cytoscopy - examination of the inner walls of the bladder. For cytoscopy, a special device is used - a cystoscope.

Influence of innervation disorders on the urinary tract

With the wrong innervation, the blood supply to the organs of the urinary tract is disrupted. So, with a neurogenic bladder, cystitis often joins, which can cause a microcyst.

A microcyst is a decrease in the size of the bladder due to chronic inflammation. With a microcyst, the function of the bladder is significantly impaired. The microcyst is one of the most difficult complications of chronic cystitis and neurogenic bladder.

With residual urine in the bladder, the risk of inflammatory diseases urinary tract. If the neurogenic bladder is complicated by cystitis, then this poses a health hazard and sometimes requires surgical intervention.

Diagnosis and treatment of neurogenic bladder and its type

In this case, medical, non-drug treatment is used. To restore the reflex function of the sphincters and their activity with the detrusor, electrical stimulation of the muscles of the bladder, groin, and sphincter of the anus is prescribed.

To restore and activate the efferent links of the ANS, calcium ion antagonists, adrenomimetics, coenzymes, and cholinomimetics are prescribed. Frequently used: Aceclidine, Ephedrine hydrochloride, Cytochrome C, Isoptin.

To maintain and restore the regulation of the ANS, the doctor individually selects tranquilizers and antidepressants.

In exceptional cases, appointed surgery... Based on the reasons, the nervous apparatus of the organ or the plastic of the musculo-ligamentous apparatus can be adjusted.

Disruption of the innervation of the bladder is common. It is important to take steps at the first symptoms to correct the problem.

In order to restore the normal innervation of the bladder, the following methods are used:

1. electrical stimulation (urine collector, groin muscles and anal sphincter).
2. drug therapy (coenzymes, adrenomimetics, cholinomimetics, calcium ion antagonists).
3. taking antidepressants, tranquilizers.
4. taking anticholinergic, anticholinergic drugs, andrenostimulants.

Unfortunately, there is no therapy for disorders of the innervation of the bladder using folk remedies... For any problems with dysfunction of urination, you should immediately contact a urologist. Truth to improve efficiency drug therapy you should move more, regularly walk in the fresh air, perform exercises according to the method of exercise therapy (physical therapy).

Treatment of the disorder depends on the etiology of the disease, as well as on concomitant inflammatory diseases. There are four types of effective conservative treatment:

• Electrical stimulation. Sphincter reflexes can be activated by applying electrical stimulation to the groin and anal sphincter muscles. The procedure restores the connection between the sphincter and the detrusor.
• Medication therapy. Isoptin, Aceclidine or Cytochrome C is prescribed to activate the efferent impulses of the ANS. Preparations based on: coenzymes, calcium ion antagonists, adrenomimetics and cholinomimetics.
• Tranquilizers and antidepressants act in a complex manner on the entire nervous system.
• Cholinergic, anticholinergic drugs restore the ability to control the process, stabilize the pressure inside the organ.

In other cases, a decision is made to carry out surgery.

Effects

Untimely treatment of disorders of the innervation of the bladder can lead to unpleasant consequences. The quality of life may be significantly impaired: sleep will be restless, the patient may suffer from depression, others psychological disorders... Chronic cystitis may also occur, chronic renal failure, pyelonephritis, vesicoureteral reflux.

The innervation of the bladder in any of its manifestations negatively affects human health and can lead to trophic disorders. In case of deviations in the functioning of the sac-shaped organ with nerves, the blood supply to the urinary organs fails.

In addition to the whole bouquet of unpleasant sensations, cystitis may also begin to disturb, which can be re-transformed into microcystitis. Microcystitis leads to a decrease in the size of the bladder due to chronic inflammation... Microcystitis quite strongly and negatively affects all functions of the bladder. This disease is characterized as the most dangerous among chronic cystitis and neurogenic bladder.

Residual urine increases the risk of organ infections and inflammation throughout the canal. Usually, neurogenic bladder disease complicated by cystitis is resolved with surgical methods.

The trophic function of nerves is of less importance for the normal functioning of tissues than blood supply, but at the same time, a violation of innervation can lead to the development of superficial necrosis - neurotrophic ulcers.

A feature of neurotrophic ulcers is a sharp inhibition of reparative processes. This is largely due to the fact that it is difficult to eliminate or at least reduce the influence of the etiological factor (disturbed innervation).

Neurotrophic ulcers can form with damage and diseases of the spinal cord (spinal trauma, syringomyelia), damage to peripheral nerves.

The main types of necrosis

All of the above diseases lead to the development of necrosis. But the types of necrosis themselves are different, which has a significant impact on the tactics of treatment.

Dry and wet necrosis

It is fundamentally important to separate all necrosis into dry and wet ones.

Dry (coagulative) necrosis characterized by gradual drying of dead tissues with a decrease in their volume (mummification) and the formation of a clear demarcation line separating the dead tissues from normal, viable ones. In this case, the infection does not join, the inflammatory reaction is practically absent. The general reaction of the body is not expressed, there are no signs of intoxication.

Wet (colliquation) necrosis characterized by the development of edema, inflammation, an increase in the volume of the organ, while around the foci of necrotic tissues hyperemia is expressed, there are bubbles with a transparent or hemorrhagic fluid, the outflow of turbid exudate from skin defects. There is no clear boundary between the affected and intact tissues: inflammation and edema spread beyond the necrotic tissues over a considerable distance. The addition of a purulent infection is characteristic. With wet necrosis, severe intoxication develops (high fever, chills, tachycardia, shortness of breath, headaches, weakness, profuse sweat, changes in blood tests of an inflammatory and toxic nature), which, as the process progresses, can lead to organ dysfunction and death of the patient. The differences between dry and wet necrosis are presented in table. 13-2.

Thus, dry necrosis proceeds more favorably, is limited by a smaller volume of dead tissues and carries a much lower threat to the patient's life. In what cases does dry necrosis develop, and in what cases does wet necrosis?

Table 13-2. The main differences between dry and wet necrosis

Dry necrosis is usually formed when the blood supply to a small, limited area of \u200b\u200btissue is disturbed, which does not occur immediately, but gradually. More often dry necrosis develops in patients with reduced nutrition, when there is practically no fatty tissue rich in water. For the occurrence of dry necrosis, it is necessary that there are no pathogenic microorganisms in this zone, so that the patient does not have concomitant diseases that significantly worsen immune responses and reparative processes.

Unlike dry necrosis, the development of wet necrosis is promoted by:

Acute onset of the process (damage to the main vessel, thrombosis, embolism);

Large volume ischemia (eg, thrombosis of the femoral artery);

Expression in the affected area of \u200b\u200btissues rich in fluid (fatty tissue, muscles);

Accession of infection;

Concomitant diseases (immunodeficiency states, diabetes mellitus, foci of infection in the body, insufficiency of the circulatory system, etc.).