Sacral dysplasia
Introduction
Introduction Malformations such as sacral dysplasia, spina bifida, and meningocele are clinical manifestations of neurogenic bladder. Bladder urethral dysfunction caused by damage to the central nervous system or peripheral nerves that control urinary function is called a neurogenic bladder. Treatment of the neurogenic bladder mainly protects the kidney function, prevents renal pelvis and kidney fire, hydronephrosis leads to chronic renal failure, and secondly improves the symptoms of urination to alleviate the pain in life. The specific measure of treatment is to use various non-surgical or surgical methods to reduce residual urine volume.
Cause
Cause
1. Spinal cord or brain injury.
2. Central nervous surgery or extensive pelvic surgery: such as radical resection of rectal cancer, radical uterine cancer, pelvic lymphadenectomy.
3. Congenital diseases: such as spina bifida, spinal meningocele, tibia deformity, tibia dysplasia.
4. Drug effects: drugs that affect sympathetic and parasympathetic functions, such as probufen, atropine, alcohol, nitinol, and drugs for lowering blood pressure, desensitization, antihistamine, etc. can affect the central nervous system.
5. Certain diseases: diabetes, syphilis, tremor palsy, spinal corditis, encephalitis, stroke, myelitis, etc.
Examine
an examination
Related inspection
Bone and joint MRI examination ankle joint examination
diagnosis
Diagnosing a neurogenic bladder consists of two parts. First, it should be clear whether urinary dysfunction is caused by neuropathy, and secondly, which type of neurogenic bladder belongs.
1. Whether urinary dysfunction is caused by neuropathy:
1. History:
1 urinary dysfunction with defecation dysfunction (such as constipation, fecal incontinence, etc.), the possibility of neuropathy through the original bladder.
2 pay attention to whether there is history of trauma, surgery, diabetes, polio, or history of drug application.
3 pay attention to the presence or absence of urinary sensation, bladder swelling and other feelings of decline or loss, such as the bladder's sensation is significantly reduced or increased, you can diagnose the neurogenic bladder.
2. Examination: 1 When the perineal sensation is reduced, the anal sphincter tension is reduced or enhanced, the neurogenic bladder can be diagnosed, but the lack of these signs can not rule out the possibility of neurogenic bladder.
2 pay attention to the presence or absence of spina bifida, meningocele, tibia dysplasia and other deformities.
3 There is residual urine, but there is no mechanical obstruction of the lower urinary tract.
4 Electrical stimulation of spinal cord reflex test, this method mainly tests whether the spinal reflex nerves of the bladder and urethra are intact (ie, whether there are lesions in the lower motor neurons) and whether the neurons from the cerebral cortex to the pudendal nucleus (the spinal cord center) have lesions ( Upper motor neurons have no lesions). Therefore, this test can be diagnosed as a neurogenic bladder, and can distinguish between lower motor neuron lesions (detrusor non-reflection) and upper motor neuron lesions (detrusor hyperreflexia).
Diagnosis
Differential diagnosis
The neurogenic bladder needs to be differentiated from the following diseases:
1. Benign prostatic hyperplasia: occurs in men over 50 years old, has dysuria, urinary retention, severe cases of kidney, ureteral expansion and accumulation of water. Rectal examination, cystoscopy, and cystography can confirm the diagnosis.
2. Bladder neck obstruction: Women have dysuria and urinary retention, normal skin around the anus and perineal sensation, cystoscopy or urodynamic examination can be identified.
3. Congenital urethral valve: more common in children, dysuria, urinary retention. Urethroscopy or urethrography can be identified.
4. Female stress urinary incontinence: normal detrusor function, decreased urethral resistance, positive bladder neck elevation test, bladder urethra angiography disappeared posterior urethral urethra, bladder neck position decreased.
5. Urethral stricture: can be congenital or acquired, with dysuria as the main performance. The urethral probe has a strict stenosis, and urethrography can confirm the diagnosis.
6. Bladder neck obstruction: dysuria is often accompanied by urination pain, sudden interruption of urinary flow during urination. Ultrasound examination showed a strong echo. The opaque shadow of the plain area of the bladder area. Cystoscopy can determine the size and number of stones.
