Neurogenic bladder is not timely, easy to be complicated by urinary tract infection, vesicoureteral reflux, pyelonephritis, renal failure, hydronephrosis and other complications, for neurogenic bladder, the current clinical according to urinary storage and urination disorders, there are drugs, bladder enlargement, sacral nerve regulation**, intermittent catheterization of urination disorders, indwelling catheterization, fistula and other methods.
*What does the upper and lower urinary tract consist of?
The human urinary system consists of four parts: kidneys, ureters, bladder, and urethra. Among them, the kidneys and ureters are the upper urinary tract, and the bladder and urethra are the lower urinary tract.
Upper urinary tract protection must be taken into account while solving voiding disorders.
The kidneys of the upper urinary tract produce urine, and if something goes wrong, it will cause kidney failure, become uremia, and be life-threatening, so it must be protected. The presence of hydronephrosis or pyelonephritis must be taken seriously. In pyelonephritis, there is a high fever, chills, and backache. The ureters are used to transport urine and protect the kidneys. When urine reflux or hydronephrosis occurs, the ureters dilate and must be taken seriously.
The lower urinary tract bladder is the organ that stores urine and urination, and we have urination disorders because the bladder loses nerve control (that is, the bladder does not listen to the brain), so it will be incontinent or retained. There can also be infections of the lower urinary tract, cystitis, urethritis. After a long period of slow staining, the bladder wall will thicken, resulting in trabeculae and diverticulum. The bladder loses its ability to contract for a long time, and atrophy occurs. Lower urinary tract problems generally do not directly affect the body, but bladder urine reflux can affect the kidneys and must also be taken seriously.
If there is no fever in the lower urinary tract, it is called "asymptomatic bacteriuria", and it is allowed to coexist with a small number of white blood cells without antibiotics, as long as you drink plenty of water, urinate frequently, and avoid the presence of residual urine.
Neurogenic bladder should be observed non-invasive, minimally invasive, and then invasive.
The literature suggests that renal failure is the leading cause of death in patients with neurogenic bladder due to spinal cord injury. Detrusor hyperactivity or decreased bladder compliance can lead to bladder pressure beyond a safe limit during the storage phase, whereas detrusor-sphincter synergy or bladder outlet obstruction can result in bladder pressure beyond a safe range during voiding. The primary goal is to control the bladder pressure during the bladder storage period and or voiding period within a safe range, reduce the incidence of upper urinary tract damage, and ensure the long-term survival rate of the patient.
The principles of neurogenic bladder include:
1) First of all, it is necessary to actively ** the primary disease, and before the primary nervous system lesion is not stable, it should be conservative.
2) The selection of ** methods should follow the principle of gradually moving from non-invasive, minimally invasive, and then to invasive.
3) Urinary tract function status cannot be determined solely based on medical history, symptoms and signs, and the degree and level of neurological damage, and imaging urodynamic examination is of great significance for the determination of the regimen and the selection of the method. When formulating the first plan, it is necessary to comprehensively consider the patient's gender, age, physical condition, socioeconomic conditions, living environment, potential risk and benefit ratio, and formulate the first plan in combination with the individual situation of the patient.
4) The condition of patients with neurogenic bladder is clinically progressive, so patients with neurogenic bladder should be followed up regularly after **, and the follow-up should be accompanied by life, and the ** and follow-up protocol should be adjusted in time when the disease progresses.