Neurogenic Bladder

Definisi

Neurogenic bladder merupakan penyakit

yang menyerang kandung kemih yang
disebabkan oleh kerusakan ataupun
penyakit pada sistem saraf pusat atau
pada sistem saraf perifer dan otonom
yang terlibat dalam pengendalian
berkemih.
 Neurogenic
Bladder

Underactive Overactive
Bladder Bladder
Epidemiologi

In a large cohort study, the mean age of neurogenic bladder patients was 62.5
years and resultant aetiologies included 4:
multiple sclerosis: ~17%
Parkinson disease: ~15%
cauda equina syndrome: ~9%
paralytic syndrome: ~8%
stroke complications: ~6%
Klasifikasi

Sensory Neurogenic Bladder :

Posterior columns of the spinal cord or afferent tracts leading from the
bladder
Inability to sense bladder fullness results in a large rounded and smooth
bladder. Voiding is often preserved
Motor Paralytic Bladder
Damage to motor neurons of the bladder
Atonic large bladder with inability of detrusor contraction during voiding
Uninhibited Neurogenic Bladder
Incomplete spinal cord lesions above S2 or cerebral cortex or cerebropontine
axis lesions
Rounded bladder with a trabeculated apperance to the mucosa above the
trigone from detrusor contractions. On voiding large interureteric ridge is
noted
Reflex Neurogenic Bladder
complete spinal cord lesions above S2 - may lead to pine cone bladder
Results from detrusor hyperreflexia with a dyssynergic sphincter. This leads to
contrast extension to the posterior urethra and an elongated pointed urthera
with pseudodverticula.
Autonomous Neurogenic Bladder
Conus or cauda equina lesions
Intermediate between detrusor hyperreflexia (contracted) and dysreflexia
(atonic).
Pine Cone Bladder

A pine cone bladder or christmas tree bladder is a cystogram appearance in

which the bladder is elongated and pointed with thickened trabeculated wall.
It is typically seen in severe neurogenic bladder with increased sphincter tone
(detrusor sphincter dyssynergia) due to suprasacral lesions (above S2-S4) or
epiconal lesions (in and around S2-S4).
However, these findings are not pathognomonic of a neurogenic bladder and
can be seen in patients with lesions anywhere along the sacral reflex arc
leading to poor detrusor compliance. Occasionally, it is also seen in bladder
neck obstruction of a non-neurogenic cause.
Elongated urinary bladder with
a conical shape towards the
dome of the bladder like a
tree. The bladder wall
hypertrophy gives rise to the
irregular outline.
There is tree shaped urinary bladder with wall
hypertrophy which cause irregular outline. Features
compatible with Christmas tree appearance due
to neurogenic bladder.
VCUG

Voiding cystourethrography (VCUG), also known as a micturating

cystourethrography (MCU), is a fluoroscopic study of the lower urinary tract
in which contrast is introduced into the bladder via a catheter. The purpose of
the examination is to assess the bladder, urethra, postoperative anatomy and
micturition in order to determine the presence or absence of bladder and
urethral abnormalities, including vesicoureteral reflux (VUR).
It is more commonly performed in the paediatric population than adults.
Indikasi

urinary tract infection

dysuria
dysfunctional voiding
hydronephrosis and/or hydroureter
bladder outlet obstruction
haematuria
trauma
incontinence
neurogenic dysfunction of the bladder, e.g. spinal dysraphism
congenital anomalies of the genitourinary tract
postoperative evaluation of the urinary tract
Fever 39C (102.2F) and a pathogen other than E. coli after a first febrile
urinary tract infection in a child is also considered a strong indication due to an
increased risk of renal scarring in this population 2.
Procedure

The bladder is filled with contrast using an infant feeding tube under aseptic
precautions; a foley catheter can be used for older children
Intermittent screening of the patient on fluoroscopy, while distending the
bladder with contrast, is necessary to check for a ureterocoele or VUR
After the bladder is filled to its capacity (which will vary as per age of
patient) the patient is now asked to void
The following projections should be acquired keeping within
the ALARA principle:
AP with full bladder for demonstration of the presence or absence of VUR.
Both obliques to demonstrate bilateral vesicoureteric junctions.
Post void film to check for a ureterocoele.
Posisi

AP with full bladder for demonstration of the presence or absence of VUR.

both obliques to demonstrate bilateral vesicoureteric junctions.
post void film to check for a ureterocoele
Thank You