Bọng đái thần kinh

Bọng đái rối loạn chức năng do bệnh lý thần kinhtrung ương hoặc ngoại biên. II. TỪ KHÓA: anticholinergic, thông tiểu, khả năng giãn nở bàngquang, áp lực đồ bọng đái, soi BQ, tk vận động, giao cảm và phó giao cảm, ứ nước thượng nguồn, suy thận do trào ngược, chuyển lưu nước tiểu ra da.
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Bọng đái thần kinh Bọng đái thần kinh ĐỊNH NGHĨA: Bọng đái rối loạn chức năng do bệnh lý thần kinhI.trung ương hoặc ngoại biên. TỪ KHÓA: anticholinergic, thông tiểu, khả năng giãn nở bàngII.quang, áp lực đồ bọng đái, soi BQ, tk vận động, giao cảm và phó giao cảm, ứ nướcthượng nguồn, suy thận do trào ngược, chuyển lưu nước tiểu ra da.III. NGUYÊN NHÂN: BỆNH TỦY SỐNG: chấn thương, ung thư (nguyên phát hoặc thứ phát),A.thoát vị đĩa đệm, bệnh lý nội khoa của tủy sống, dị tật ống tủy, cột sống chẽ đôi…B. NÃO: u não, TBMMN, THẦN KINH NGOẠI BIÊN: sau mổ vùng chậu ( sacrococcycealC.teratoma)…IV. SINH LÝ: PHA ĐỔ ĐẦY:A. PHA TỐNG SẠCHB. SINH LÝ BỆNH:V.A. Brain lesionLesions of the brain above the pons destroy the master control center, causing acomplete loss of voiding control. The voiding reflexes of the lower urinary tract—the primitive voiding reflex —remain intact. Affected individuals show signs ofurge incontinence, or spastic bladder (medically termed detrusor hyperreflexia oroveractivity). The bladder empties too quickly and too often, with rel atively lowquantities, and storing urine in the bladder is difficult. Usually, people with thisproblem rush to the bathroom and even leak urine before reaching theirdestination. They may wake up frequently at night to void.Typical examples of a brain lesion are stroke, brain tumor, or Parkinson disease.Hydrocephalus, cerebral palsy, and Shy-Drager syndrome also are brain lesions.Shy-Drager syndrome is a rare condition that also causes the bladder neck toremain open.B. Spinal cord lesionDiseases or injuries of the spinal cord between the pons and the sacral spinal cordalso result in spastic bladder or overactive bladder. People who are paraplegic orquadriplegic have lower extremity spasticity. Initially, after spinal cord trauma, theindividual enters a spinal shock phase where the nervous system shuts down. After6-12 weeks, the nervous system reactivates. When the nervous system becomesreactivated, it causes hyperstimulation of the affected organs. For example, thelegs become spastic.These people experience urge incontinence. The bladder empties too quickly andtoo frequently. The voiding disorder is similar to that of the brain lesion exceptthat the external sphincter may have paradoxical contractions as well. If both thebladder and external sphincter become spastic at the same time, the affectedindividual will sense an overwhelming desire to urinate but only a small amount ofurine may dribble out. The medical term for this is detrusor -sphincter dyssynergiabecause the bladder and the external sphincter are not in synergy. Even though thebladder is trying to force out urine, the external sphincter is tightening to preventurine from leaving.The causes of spinal cord injuries include motor vehicle and diving accidents.Multiple sclerosis (MS) is a common cause of spinal cord disease in youngwomen. Those with MS also may exhibit visual disturbances, known as opticneuritis. Children born with myelomeningocele may have spastic bladders and/oran open urethra. Conversely, some children with myelomeningocele may have ahypocontractile bladder instead of a spastic bladderC. Sacral cord injurySelected injuries of the sacral cord and the corresponding nerve roots arising fromthe sacral cord may prevent the bladder from emptying. If a sensory neur ogenicbladder is present, the affected individual may not be able to sense when thebladder is full. In the case of a motor neurogenic bladder, the individual will sensethe bladder is full and the detrusor may not contract, a condition known asdetrusor areflexia. These individuals have difficulty eliminating urine andexperience overflow incontinence; the bladder gradually overdistends until theurine spills out. Typical causes are a sacral cord tumor, herniated disc, and injuriesthat crush the pelvis. This condition also may occur after a lumbar laminectomy,radical hysterectomy, or abdominoperineal resection.Some teenagers suddenly develop an abnormal voiding pattern and often areevaluated for tethered cord syndrome, a neurologic condition in which t he tip ofthe sacral cord is stuck near the sacrum and cannot stretch as the child growstaller. Ischemic changes of the sacral cord associated with the tethering cause themanifestation of dysfunctional voiding symptomsD. Peripheral nerve injuryDiabetes mellitus and AIDS are 2 of the conditions causing peripheral neuropathyresulting in urinary retention. These diseases destroy the nerves to the bladder andmay lead to silent, painless distention of the bladder. Patients with chronicdiabetes lose the sensation of bladder filling first, before the bladderdecompensates. Similar to injury to the sacral cord, affected indivi ...