The clinical manifestations of neurogenic bladder are voiding dysfunction, but due to the different locations of nerve damage, different course of disease, and different pathological changes in bladder and urethral function, how to accurately evaluate the function of bladder and urethra is particularly important for neurogenic bladder. Imaging urodynamic examination refers to the display and recording of urodynamic parameters in bladder manometry (storage and voiding phases) at the same time as the display and recording of urodynamic parameters on X-ray fluoroscopy or B-ultrasound, so as to more accurately show the relationship between bladder urethral function and morphological changes.
The clinical manifestations of patients with neurogenic bladder vary from person to person and are generally divided into two categories: one is detrusor hyperreflexia (caused by uninhibited contractions), which is mainly manifested by urinary frequency, urgency and urge incontinence, abnormal bladder fullness and urge urinary intent, and some patients present with stress urinary incontinence.
The second is detrusor no reflex (the neck of the bladder cannot or is not fully opened when the patient urinates), which is often manifested as difficulty urinating, incomplete bladder emptying, urinary retention, feeling the feeling of bladder distention, unable to urinate when you want to urinate, overflowing urinary incontinence in severe cases, the bladder is like a jar, overflowing when the urine is full, and in severe cases, hydronephrosis appears. In addition to urinary symptoms, it is also accompanied by constipation, fecal incontinence, and decreased or lost sensation.
Neurogenic bladder requires imaging urodynamics.
In addition to ultrasonography to check residual urine, the most convincing test for the above voiding symptoms is imaging urodynamic examination. The history and mode of urination should be fully understood before the examination, and low-speed perfusion should be used for patients with suspected small volume and low compliance of the bladder. During bladder filling, bladder sensation and volume, bladder detrusor stability, and bladder wall compliance should be observed.
1. General urodynamic examination. Including urinary flow rate measurement, bladder pressure volume measurement, urethral manometry, urine leakage point pressure measurement, electromyography and other items.
2. Imaging urodynamics. At the same time, it can observe the contraction of bladder detrusor muscle and the opening of the bladder neck at the maximum urine flow rate, comprehensively and dynamically monitor the activity of bladder and urethra, and intuitively and clearly observe the activities of bladder detrusor and urethral sphincter during the storage period, voiding period, bladder detrusor and urethral sphincter after urination, as well as the coordination process of the two.
In many hospitals, imaging urodynamic testing is not available, but urodynamic testing and cystography can be performed in this case.
After clarifying the type of bladder, we should carry out systematic standardization**, neurogenic bladder we need to protect the function of the upper urinary tract (protect the function of the kidneys), reduce vesicoureteral reflux, prevent hydronephrosis from leading to chronic renal failure, and ensure that the bladder pressure during the storage and voiding phases is within a safe range. In order to partially restore the function of the lower urinary tract, improve urinary control and voiding ability, reduce residual urine volume, reduce urinary incontinence, and prevent urinary tract infections, patients can regularly discharge urine in order to engage in daily activities.