Neurogenic bladder in a child. Neurogenic bladder: causes, diagnosis and treatment

Neurogenic dysfunction of the bladder is a violation of the normal activity of the body. Pathology is widespread enough. In urology and pediatric pediatrics, about 10% of all diseases of the urinary system occupy this particular ailment. Along with this, the risk of changes in the organs of the secondary system is increased. Morbidity disorder is caused by a violation of nervous regulation at the peripheral or central level. Next, consider what is neurogenic dysfunction of the bladder at a young age.

General information

Neurogenic bladder in women is due to severe labor, surgical interventions of gynecological nature, as well as chronic pathologies of pelvic organs. The disease can appear suddenly or progress gradually. Neurogenic bladder in men often occurs against the background of prostate adenoma, and also after prolonged activity associated with lifting the severity. In pathology, a person observes the discharge of urine drop by drop and the inability to keep it in stressful situations. Neurogenic bladder in a child can have a primary form. In this case, the hereditary nerve pathologies act as a provoking factor. Urination at an early age can be secondary. In this case, the formation of pathology occurs under the influence of exogenous or endogenous factors.

Formation of the reflex

The child has a fully controlled mature mode of urination formed by 3-4 years of age. The system goes through several stages of development - from a spinal unconditioned reflex to an arbitrary reflex act. Subcortical and cortical brain centers, spinal innervation zones in the lumbosacral spinal cord, and peripheral nerve plexuses participate in the regulation of fluid withdrawal. Neurogenic bladder in a child is accompanied by violations of innervation and reserve-vacuum processes. Pathology can provoke a number of serious diseases. These include, in particular, chronic kidney failure, pyelonephritis, cystitis, hydronephrosis, megaurethra, vesicoureteral reflux.

The provoking factors

Neurogenic dysfunction of the bladder develops due to various neurological disorders. They lead to a decrease in the coordination of the activity of the external sphincter or detrusor during the accumulation and release of fluid. Neurogenic bladder in a child can develop against a background of CNS lesions of an organic nature. They, in turn, can be provoked by traumas, inflammatory-degenerative and tumor pathologies of the spinal column, congenital malformations, diseases of the spinal cord and brain. To ailments, against which the neurogenic bladder develops in a child, include spinal hernia, birth trauma, dysgenesis and agenesis of coccyx and sacrum, cerebral palsy and others. They lead to complete or partial dissociation of spinal and supraspinal nerve centers and organ. The most common pathology is found in girls. This is due to increased estrogenic saturation, which increases the sensitivity of detrusor receptors.

Classification

In accordance with the changes in the cystic reflex, several types of pathology are distinguished. With a hyperreflex urinary bladder, a spastic condition occurs in the stage of fluid accumulation. Giporeflektorny type of pathology is accompanied by detrusor hypotension in the phase of excretion. For him, the emergence of a reflex to urination with a functional volume of the bladder, significantly larger than normal in age. When hyperreflexion, the appearance of the reaction is noted long before the accumulation of the prescribed amount of liquid. The type of pathology is the most severe. It is accompanied by the inability to self-contract the overcrowded and full bladder, as well as an involuntary act of emptying. Pathology is also classified according to the degree of detrusor fitness to the increasing volume of fluid. So, the neurogenic bladder can be unadapted (uninhibited) and adapted. Several forms of the disease are also distinguished. In particular, with a mild form of the patient, the bladder empties spontaneously under stressful situations. Symptoms of severe form consist in the development of Hinman syndromes - detrusor-sphincter dissection, Ochoa - urofacial pathology. With moderate forms, the instability of the organ is noted.

Clinical picture of hyperreflexia

What happens when the bladder is unstable? Symptoms of the pathology are manifested in violations of the act of emptying. Their severity and frequency of occurrence are determined in accordance with the degree of nerve damage. Neurogenic hyperactivity prevails usually in young children. In this case, there are frequent evacuations (up to eight times a day) with small volumes, imperative (urgent) urges, enuresis, incontinence. The postural neurogenic bladder, the symptoms of which appear when the horizontal position of the body changes to a vertical position, is accompanied by a day-long pollakiuria, as well as an undisturbed accumulation of urine at night with a normal volume of the morning portion. Stress incontinence is manifested by the loss of a small amount of fluid. This phenomenon can occur with physical activity. Against the background of detrusor-sphincter dissension there is absolute delay or incomplete emptying, as well as micturition (urination) during straining.

Manifestations of hyporeflexia

Against the background of this type of pathology, rare or absent urination is noted with a full or full bladder. Emptying can also be flaccid, with the peritoneal wall tension. Often there is a feeling of incomplete exit of urine. This is due to the large volume of the residue (up to 400 ml). In some children, paradoxical ishuria is likely, accompanied by an uncontrolled urinary output. This is due to the gaping of the external sphincter, which stretches under the pressure of a crowded organ. With a lazy bladder, rare urination occurs, combined with incontinence, tract infections, constipation. In the advanced stages of pathology, there is a risk of inflammation, disturbed blood flow in the kidneys, scarring of the parenchyma and the formation of a secondary type of wrinkling, chronic insufficiency and nephrosclerosis.

Diagnostics

When there is a discharge of urination, a comprehensive examination is necessary. It should involve doctors such as a pediatrician, a psychologist, a neurologist, a nephrologist, a urologist. Diagnosis includes the collection of anamnesis. There is a family predisposition to the development of pathology, whether there were injuries, diseases of the nervous system, and so on. The results of instrumental and laboratory studies are also evaluated. To identify infection and functional renal disorders against the background of pathology, a biochemical analysis of blood and urine, a Nechiporenko, Zemnitsky test, and bacteriological analysis are carried out. Urological examination includes ultrasound. Kidney and bladder are examined with determination of residual volume. An X-ray diagnostic method is also included in the examination. Perform excretory and review urography, mictional cytography. CT and MRI of the renal system, endoscopy, radioisotope scanning are also performed. Assessment of the state of the bladder is carried out by monitoring the daily volume and rhythm of spontaneous urination at the usual temperature and drinking regimen. High diagnostic significance in detecting the disease is urodynamic examination of the functional state of the lower parts of the system, uroflowmetry, measurement of internal pressure at natural filling, electromyography, profilometry, cystometry (retrograde). Echo-EG, EEG, MRI of the brain, radiography of the spine and skull are also performed with a suspected neurogenic bladder in children. Komarovsky in one of his articles describes in detail the clinical analysis (OAM).

Therapeutic events

They are appointed in accordance with the type, severity of disorders, concomitant diseases. As a rule, differentiated tactics are used. Many specialists prescribe homeopathic medicines. However, there are also such doctors who do not trust these means. For example, does not recommend homeopathic remedies if a neurogenic bladder is detected in children, Komarovsky. It should be said that the doctor is generally skeptical about this kind of therapy. Nevertheless, there are many cases in practice when homeopathy was very effective. Timely diagnosis and correctly chosen tactics of therapy allows you to quickly eliminate pathology.

Medication effect

To eliminate hypertonia, patients are assigned M-holinoblokatory. These include such drugs as "Atropine", "Oksibutinin" (for patients with five years). Also shown are tricyclic antidepressants (for example, "Melipramine"), antagonists of Ca + (they include drugs "Nifedipine", "Therodin"), nootropics (among them are drugs "Pikamilon", "Pantogam"). Motherwort infusions and valerian are also recommended in case a neurogenic bladder is diagnosed in children. Treatment with folk remedies allows to increase the effectiveness of the main therapy, and also with the least risk to alleviate the condition, since it has a minimum of side effects. In the presence of nocturnal enuresis, patients with five years of age can be prescribed an analogue of the antidiuretic steroid of the neurohypophysis - desmopressin. To prevent the development of infection, patients are recommended small doses of uroseptics. These include, in particular, nitrofurans (Furagin), oxyquinolones (5-NOC), fluoroquinolones (k-ta nalidix), Kanefron drug, immunocorrecting effects (drugs Tactivine, Levamisol) .

Additionally

To facilitate the condition, urination is scheduled according to the schedule after 2-3 hours. Also shown are regular catheterizations, the use of cholinomimetics, anticholinesterase drugs, adaptogens. Recommended baths with medicinal sea salt.

Operational methods

With a neurogenic bladder, endoscopic interventions are performed. In particular, transurethral resection of the organ neck, implantation of collagen in the urethra, intra-urethral and intra-extrinsic administration of botulinum toxin is performed. Also, there are interventions on the nervous ganglia, which are responsible for urination. With the help of intestinal cystoplasty, the bladder increases in volume.