Managing neurogenic voiding dysfunction

Posted by e-Medical PPT
Normal Voiding Function
Unique function of bladder and rectum;Autonomic and somatic control.
Distention and capacitance role for storage and emptying
Reflexic and conscious emptying.
Learned behaviors to coordinate voiding cycle and response to stimuli
Requires physical integrity of supporting structures

Innervation of the
Lower Urinary Tract
Cerebral function;anterior frontal gyrus
Pontine micturition center; coordination
Sacral reflex arcs through S3 and S4
Parasympathetic and sympathetic influences
Afferent feedback
Importance of pelvic floor

Spectrum of dysfunction in TM
Great variation in dysfunction - Mild to severe
Urinary retention – Frequency/urgency –Incontinence (spontaneous, exertional)
Degree of bladder dysfunction does not always mirror other deficits
Degree of bladder dysfunction does not always mirror recovery
Don’t forget bowel function

Evaluation
Urodynamic testing
The bladder is a poor witness
Can define accomodation of the bladder(compliance)
Sensation, residual volume, capacity
Spontaneous activity
Coordination and competence of sphincter
Voiding pressure and flow efficiency

Therapy for Neuropathic voiding
dysfunction: Hyperreflexia
Behavioral modification
Pelvic floor retraining/reeducation
Medication; oral, transdermal, intravesical
Biofeedback, E-stim, magnetic stim, PT
Sacral nerve stimulation
Denervation; surgical, chemical (botox)
Surgery; augmentation cystoplasty, urinary diversion


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