桥脑排尿中枢PONS.pptVIP

Peripheral Neuropathy and Neurogenic Voiding Dysfunction Hann-Chorng Kuo Department of Urology Buddhist Tzu Chi General Hospital Peripheral neuropathy Cauda equina syndrome Sacral root injury Pelvic plexus injury Diabetes neuropathy Detrusor denervation Consequences of peripheral neuropathy Detrusor contractions are lost Bladder becomes an acontractile sac Bladder empty by abdominal straining or suprapubic compression (Crede maneuver) or catheterization Bladder sensation becomes vague Lower urinary tract symptoms in Peripheral neuropathy Dysuria Straining to void Frequency Residual urine sensation Urinary incontinence (overflow) Urinary retention Physiology of micturition Cauda equina lesion Lumbar spinal injury Surgery for herniated disc Complete or incomplete injury to nerve roots Detrusor contractility is lost in complete lesion Recovery of detrusor contractility depends on severity of lesion Diagnosis of Cauda equina lesion History of surgical trauma Dysuria and straining to void after spine surgery Constipation is the rule Saddle anesthesia or paresthesia Lower extremity motor deficiency Urodynamics of Cauda equina lesion Detrusor areflexia at initial stage, sphincter tone is fixed (normal or weak) Bladder sensation of filling is normal or vague Bladder neck may be closed or open Bladder compliance is normal initially Patients void by abdominal straining Detrusor areflexia after cauda equina lesion Isolated sphincter obstruction in cauda equina lesions Bladder outlet in Cauda equina lesion Bladder neck may be closed due to lack of synchronized relaxation during volitional voiding Benign prostatic enlargement may increase urethral resistance Isolated striated urethral sphincter results in bladder outlet obstruction Bladder outlet obstruction due to BPH in cauda equina lesion Persistent dysuria after TURP in cauda equina lesion Chronic LUTD afterCauda equina lesion Bladder compliance turns lower than normal Bladder sensation remains vague In isolated ure