Detrusor function test

The bladder detrusor function test is an auxiliary examination method for checking whether the bladder detrusor function is normal. The examination items include filling intravesical pressure measurement, intravesical pressure measurement during urination, bladder denervation hypersensitivity test, bladder residual urine volume measurement, ice water test, anal sphincter tension test, and anal reflex test. Through the above experiments, the corresponding symptoms can be judged. Determination of intravesical pressure during urination, normal bladder function, no obstruction of lower urinary tract, the maximum intravesical pressure during urination is 35-70 cm water column, generally below 50 cm water column. Basic Information Specialist classification: urinary examination classification: other examinations Applicable gender: whether men and women apply fasting: not fasting Tips: Maintain a normal diet and sleep. Normal value Normal intravesical pressure before urination is generally below 25 cm water column. When the filling capacity of the bladder reaches I50-250 ml, there is a feeling of swelling on the pubic bone, and there is no uninhibited contraction during the filling process; when the bladder is full, there is an urgent feeling of urinating, but the urination can be started or terminated at will. The residual urine volume of the bladder was determined to be less than 5 ml under normal conditions. Determination of intravesical pressure during urination, normal bladder function, no obstruction of lower urinary tract, the maximum intravesical pressure during urination is 35-70 cm water column, generally below 50 cm water column. Clinical significance Abnormal result (1) Determination of intravesical pressure during filling period, detrusor hyperreflexia (unstable bladder) during bladder filling, or using excitation methods such as cough, position change, in situ stepping, and subcutaneous injection of urethane (Urecholine) if necessary , acetylcholine) 2.5 mg, the detrusor showed no inhibition of contraction. Clinical manifestations include frequent urination, urgency, and reduced bladder capacity. The detrusor has no reflex (stable bladder). During the filling of the bladder and after the stimulation method, the detrusor does not show non-inhibitory contraction. Clinical manifestations of dysuria, need to increase abdominal pressure to urinate, severe cases of urinary retention. (B) Determination of intravesical pressure during urination, more than 70 cm water column can determine lower urinary tract obstruction. (C) bladder denervation hypersensitivity test, if there is detrusor hyperreflexia, the above examination should be repeated the next day under spinal anesthesia or Arfonad anesthesia. For example, after the injection of urethane, the intravesical pressure is still greater than the 15 cm water column before the injection, then the neurogenic bladder caused by the upper motor neuron lesion is diagnosed. This test can have false negative or false positive results. (D) Determination of bladder residual urine volume, the appearance of residual urine indicates that the bladder urination function has been compensated. Residual urine volume is directly proportional to the degree of lower urinary tract obstruction. In the course of treatment of lower urinary tract obstruction, repeated determination of residual urine volume can determine the efficacy. (5) Ice water test, if the detrusor has no reflection, the ice water slowly flows out from the catheter. (6) Anal sphincter tension examination, such as sphincter relaxation, suggesting that the motor neuron lesions indicate that the spinal cord central activity is weakened or disappeared; if the sphincter tension is too high, the spinal cord central hyperactivity caused by motor neuron lesions is indicated. (7) Anal reflex test, using a needle to gently stimulate the skin and mucous membrane junction of the anal mouth, such as anal sphincter relaxation, indicating that there is a lower motor neuron lesion. People who need to be examined: those with abnormal bladder detrusor function. Precautions Taboo before the test: maintain a normal diet and sleep. Requirements for examination: The patient actively cooperates with the doctor, the doctor patiently operates, and carefully observes the results to ensure the results are accurate. Inspection process (1) Determination of intravesical pressure during filling period, injecting liquid or gas (carbon dioxide) into the bladder, measuring intravesical pressure during bladder filling, and plotting intravesical pressure curve to understand its relationship with capacity. (B) the determination of intravesical pressure during urination, the common method is transurethral or suprapubic bladder puncture, insert a thin catheter to the bladder, inject sterile saline to fill the bladder, when the patient discharges the fluid by itself, determine the intravesical pressure, which represents The sum of the bladder detrusor internal pressure and the intra-abdominal pressure (represented by the rectal internal pressure). (3) The bladder denervation hypersensitivity test is a specific method for determining the urinary dysfunction caused by neuropathy. After the bladder detrusor is first denervated (the motor branch of the spinal cord reflex and/or the sensory branch is damaged), the bladder muscle is hypersensitive due to the expansion of the sensory surface of the neurotransmitter (acetylcholine). . (D) Determination of bladder residual urine volume, catheterization immediately after urination or B-mode ultrasound to determine residual urine volume in the bladder. (5) In the ice water test, the bladder was evacuated with a F-16 catheter, and 60 ml of ice water at 4 ° C was quickly injected into the bladder. When the detrusor reflex is hyperthyroidism, ice water is ejected from the urethra together with the catheter in a few seconds; if the detrusor is not reflected, the ice water slowly flows out from the catheter. (6) Anal sphincter tension examination, inserting the anus with a finger to understand the sphincter tension. Such as sphincter relaxation, suggesting motor neuron lesions, indicating that the spinal cord central activity is weakened or disappeared; if the sphincter tension is too high, it indicates hyperkinesia of the spinal cord caused by motor neuron lesions. (7) Anal reflex test, using a needle to gently stimulate the skin and mucous membrane junction of the anal mouth, such as anal sphincter relaxation, indicating that there is a lower motor neuron lesion. Not suitable for the crowd Inappropriate people: This test is forbidden in acute urethritis, cystitis, and vaginal infections. Adverse reactions and risks Nothing.