Neurogenic Voiding Dysfunction

Posted by e-Medical PPT
Complications of Neurogenic voiding dysfunction
Severe lower urinary tract symptoms: dysuria, incontinence, retention
Urinary tract infection: APN, cystitis, prostatitis, epididymitis
Renal function impairment: hydronephrosis, vesicoureteral reflux, renal scarring, ESRD

Objectives of urological care for neurogenic voiding dysfunction
Preservation of renal function
Adequate bladder emptying
Prevention of UTI
Establishment of continence
Freedom of catheter
Spontaneous voiding

Urodynamic Classification NVD
Cerebral lesion – detrusor areflexia; detrusor hyperreflexia with coordinated external sphincter
Suprasacral cord lesion– autonomic dysreflexia (lesion above T6); detrusor hyperreflexia with external sphincter dyssynergia
Sacral cord lesion – detrusor areflexia with non-relaxing urethra; atonic urethra
Peripheral neuropathy – detrusor areflexia with discoordinated urethral sphincter

In Stroke
Initial retention, bladder neck is closed
Detrusor hyperreflexia & incontinence
Continence reappears by 6 Mo in 80%
Irritative LUTS: DH
Dysuria and obstructive LUTS: DHIC,BPO, poor relaxation of external sphincter (frontoparietal & internal capsule lesion)
Subcortical lesion: areflexia, retention (47%)
Areflexia in 85% hemorrhage, 10% ischemia

Stroke and Bladder outlet obstruction
Detrusor hyperreflexia in 82% after stroke, obstruction was noted in 63%
Pseudodyssynergia may be a urodynamic finding for obstructive symptoms
Incidence of BOO is equally distributed in patients with irritative and obstructive LUTS
Prostatectomy should not be done in 1 year after stroke..

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