膀胱腹直肌间置术治疗逼尿肌无反射性神经源性膀胱

目的：评价膀胱腹直肌间置术治疗神经源性膀胱的临床效果。方法：通过尿动力学检查选择逼尿肌无反射性膀胱患者8例,通过手术将膀胱置于腹直肌及其前后鞘之间,观察手术后患者症状、排尿情况及残余尿量的改变。结果：手术后62．5％的患者可自行排尿,症状好转或消失;手术后残余尿量较手术前有显著性减少。结论：膀胱腹直肌间置术是治疗神经源性膀胱的有效方法之一,有利于患者的康复。     

回肠膀胱术治疗神经源性膀胱功能障碍

目的 回顾分析回肠膀胱术治疗神经源性膀胱功能障碍的疗效和安全性。方法 2004年6月～2006年10月，对 7例神经源性膀胱功能障碍患者实施回肠膀胱术治疗。其中男5例，女2例，平均年龄27岁（17～56岁）。平均随访15个月（2～30个月），随访内容包括有无并发症和生活质量。结果 随访期内，患者未出现严重的并发症，生活质量较术前提高。结论 回肠膀胱术是治疗神经源性膀胱功能障碍患者的安全、有效、可接受的治疗措施。     

非神经源性逼尿肌膀胱颈协同失调

报告５例原发性膀胱颈功能障碍患者表现为排尿时膀胱颈开放不良，病变为逼尿肌膀胱颈协同失调，可命名为非神经源性逼尿肌膀胱颈协同失调。提示其诊断标准：（１）有下尿路功能性梗阻；（２）排尿时膀胱颈开放不良，膀胱内压－膀胱颈内压梯度异常；（３）无影响膀胱尿道功能的神经系疾患。同时对此症的发病机理和治疗选择进行了讨论。     

腹直肌转位术治疗小儿逼尿肌无反射性神经源性膀胱(附22例报告)

目的 :探讨小儿神经源性膀胱的手术治疗指征及疗效。方法 :对 2 2例小儿神经源性膀胱的患儿 ,经膀胱测压、尿道测压、冰水实验、膀胱造影等检查 ,确定是逼尿肌无反射 ,且不并发输尿管反流 ,尿道压力在正常范围内者行腹直肌转位术。结果 :本组 2 2例患者 ,2 0例尿失禁症状明显好转 ,能自行排尿 ,剩余尿量明显减少 ,2例尿失禁症状无改善。术后 10例测最大尿流率 >15ml/s。 4例术前肾功能中度受损患儿 ,3例术后肾功能明显改善 ,5例术前肾功能轻度受损患儿 ,4例肾功能恢复正常。结论 :此手术对于保护患儿的肾功能及提高生活质量有较好的作用。是治疗小儿逼尿肌无反射性神经源性膀胱的可行手术方法     

膀胱扩大术治疗神经源性小容量低顺应性膀胱

膀胱扩大术可有效治疗神经源性小容量低顺应性膀胱,可以避免上尿路进一步损害,改善患者生活质量。作者对有关文献进行综述。     

神经源性膀胱的诊断和治疗原则同样适用于非神经源性膀胱吗？

正常排尿活动是由脊髓、脊髓上反射中枢及交感、副交感、体神经共同参与完成。任何与排尿有关的中枢和周围神经受到损伤引起的膀胱功能障碍,即为神经源性膀胱（neurogenic bladder,NB）。其病因包括：①外周神经病变：糖尿病和感染性疾病;②中枢神经病变：神经脱髓鞘病变（多发性硬化症）、老年性痴呆、基底节病变、脑血管病变、额叶脑肿瘤和椎间盘疾病压迫脊髓,等;     

经尿道内括约肌切断术治疗逼尿肌无反射神经源性膀胱功能障碍

目的探讨非截瘫型逼尿肌无反射神经源性膀胱功能障碍的诊断治疗方法。方法回顾分析经尿道内括约肌切断术治疗18例非截瘫型逼尿肌无反射神经源性膀胱功能障碍并随访疗效。结果术前肾功能异常或肾积水的患者10例,其中9例恢复正常;18例术前留管或残余尿〉50mL,术后15例排尿通畅,残余尿减少到50mL以下。随访半年至11年优良率83.3%。结论内括约肌完全切断为治疗逼尿肌无反射神经源性膀胱功能障碍的重要措施。     

神经源性膀胱的治疗进展

正常的排尿活动由脊髓反射中枢及脊髓上反射中枢和交感、副交感、体神经共同参与完成。任何与排尿有关的神经受到损伤,引起的排尿功能障碍,即为神经源性膀胱。随着影像学诊断和尿动力学检查技术的进步,神经源性膀胱的诊断已无困难,但临床治疗仍无一个比较完美的方法。神经源性膀胱的分类很多,有Nesbit法、Bors法、Herschom法、Wein法等。无论哪一种分类方法,对于治疗的指导目的,都是正确评估危险因素,确定恰当的治疗策略,因为对神经源性膀胱的正确诊断是准确治疗的基础。治疗的根本目的是保护肾功能,其次是改善排尿症状以提高生活质量。其…     

神经源性膀胱诊断与治疗

正常排尿活动由脊髓反射中枢及脊髓上反射中枢和交感、副交感、体神经共同参与完成.控制排尿的中枢或周围神经系统受到损害所引起的下尿路储尿及排尿功能障碍称为神经源性膀胱.所有可能累及有关储尿和/或排尿生理调节过程的神经系统病变,都有可能影响膀胱和/或尿道功能.诊断神经源性膀胱必须有明确的相关神经系统病史.     

两种膀胱扩大术治疗神经源性膀胱比较分析

目的:比较膀胱自扩大术和回肠膀胱扩大术治疗神经源性膀胱的临床效果。方法:回顾分析膀胱自扩大术10例,回肠膀胱扩大术13例患者临床资料,对两种术式的手术方法,手术前后患者膀胱容量,肾功能以及临床症状进行比较。结果:膀胱自扩大术和回肠膀胱扩大术的患者术后平均安全膀胱容量显著增多,分别为(178.2±31.8)vs(420.7±54.9)ml,(115.9±19.5)vs(517.4±48.3)ml(P<0.05),顺应性明显改善。前者尿失禁消失8例,明显改善1例;术后血清肌酐水平恢复正常6例,明显下降2例,肾积水明显缓解或消失,未发现膀胱输尿管反流现象;后者尿失禁消失9例,明显改善2例,血清肌酐水平6例恢复正常,1例明显下降,肾积水情况均较术前明显缓解或消失,膀胱输尿管反流消失;术后3例出现尿路感染;1例轻微漏尿;1例出现腹泻;3例出现肠梗阻;2例出现膀胱结石,均对症处理后好转。结论:膀胱自扩大术较为简单、安全,但其适应证把握应慎重。回肠膀胱扩大术是治疗神经源性膀胱有效的手术方式,其适应证相对广,但并发症较多。     

Detrusor Areflexia in a Patient with Myasthenia Gravis

Myasthenia gravis (MG) is a common neuromuscular disorder, however, voiding dysfunction in conjunction with MG is rare. A review of the literature yielded only 7 prior reports of such a combination. Most of the reported cases involved incontinence in males which developed after a transurethral resection of the prostate. Only 3 cases described de novo voiding dysfunction. We report a fourth patient. In all 4 cases of de novo dysfunction, the voiding problem either heralded a new diagnosis of MG or an exacerbation of the disease process. It is hypothesized that autonomic dysfunction in patients with MG might indicate a unique subset with a worse prognosis.     

Conservative Treatment of Patients with Neurogenic Bladder

ObjectivesTo review the up-to-date literature of the mostly used conservative treatment modalities in patients with neurogenic bladder.Methodsmaterial from literature on conservative management in patients with neurogenic bladder was reviewed. Pubmed search results and recent books were consulted.ResultsThe conservative treatment is in almost all cases the first and will remain the primary choice in the majority of patients with neurogenic bladder. Treatment will depend on the type of underlying disease, on the bladder dysfunction, its natural evolution but also on the patients’ general condition, and the available resources. Behavioural training, catheters, external appliances, drugs and electrical stimulation are presented, their indications and limitations.ConclusionsConservative treatment is the mainstay in neurogenic bladder management. It offers different methods which permit to successfully treat most symptoms and conditions in this prevalent LUT pathology.     

Electrovesicogram in the Neurogenic Bladder

The vesical electric activiry was studied by electrovesicogram (EVG) in 24 patients with spinal cord injury: 15 with upper (UMNL) and 9 with lower (LMNL) motor neuron lesion. Mean age was 48.3 years; 16 were men and 8 were women. Eight healthy volunteers acted as controls. Transcutaneous recording was done with both a full and empty urinary bladder. Three electrodes were applied supra-pubically and one reference electrode was applied to the lower limb. The normal volunteers recorded regular triphasic pacesetter potentials (PPs), which were reproducible in the individual subject. The electrovesicographic pattern was similar in the full and empty bladder, except that the PPs of the latter had a lower amplitude. The patients with UMNL showed “dysrhythmic” pattern with irregular rhythm, amplitude, and frequency in both the fill and empty urinary bladder. Patients with “LM” exhibited “silent” EVG. The results indicate that electrovesicography could be used as an investigative tool that may help in the diagnosis of such conditions. The technique is simple, easy, noninvasive, and without complications