Bladder nerve stripping

When the spinal reflex center or its peripheral nerves develop lesions, it is called lower motor neuron lesions, and when any part of the spinal reflex center occurs, it is called motor neuron lesions. There are three common types of neurogenic urinary dysfunction. 1 Detrusor hyperreflexia: caused by upper motor neuron lesions. The main symptoms are frequent urination, urgency, and urge incontinence. There is no inhibitory contraction in the measurement of intravesical pressure, especially in the position change and the upright position. 2 detrusor no reflection: mostly caused by lower motor neuron lesions. The main symptoms are dysuria, urinary retention and overflow urinary incontinence. There is a loose sputum during bladder pressure measurement, and there is no bladder contraction after various stimuli. During electrical stimulation of the spinal cord reflex test, the EMG activity of the bladder wall, neck and anal sphincter was abolished or attenuated. 3 Synergistic disorders of detrusor and sphincter function: urination is a synergistic action. The contraction of the detrusor and the opening of the bladder neck and external urinary sphincter must be carried out in order to allow the urine to be completely discharged. If the detrusor and sphincter function are dysfunctional, the urine cannot be discharged or only partially discharged. There are two clinical situations: 1 Detrusor and bladder neck function synergy: mainly occurs in lower motor neuron lesions or primary sensory neuron lesions. The inhibitory effect on the sympathetic nerve is weakened by the damage of the parasympathetic nerve, resulting in an increase in contraction of the bladder neck. Clinical manifestations include dysuria, urinary weakness, urination, frequent urination, urgency, and repeated urinary tract infections. During urodynamic examination, the intravesical pressure during urination was significantly increased (6.86 kPa, ie 70 cm H2O), and the maximum urinary flow rate was low (<10 ml/s). On the urination movie, it can be seen that the bladder neck does not open or open early after opening. It can also be expressed as a tension-free bladder, with low intravesical pressure during urination and inability to open the bladder neck. 2 detrusor and extra-urethral sphincter dysfunction: often occurs in a variety of neurogenic bladder dysfunction. Clinically divided into 2 categories. One type is persistent sputum or sudden non-inhibitory contraction of the external sphincter during detrusor contraction. The other type is sudden involuntary relaxation of the external sphincter and causes urinary incontinence. Clinically, the main manifestations are dysuria, slow urine flow, urination, urinary retention, frequent urination, urinary incontinence and repeated urinary tract infections. During urodynamics and electromyography, intravesical pressure during urination increased, maximum urinary flow rate decreased, and EMG activity increased. In recent years, great progress has been made in the treatment of neurogenic urinary dysfunction, which has led to a reduction in the number of cases of open surgical treatment. Drugs that improve urinary status continue to emerge, such as M receptor antagonists, alpha-receptor antagonists, smooth muscle or skeletal muscle relaxants, which are used continuously in clinical practice and achieve good results. In particular, electrical stimulation therapy has made breakthroughs in both research and clinical application. It has been studied in various reflex arcs of the urine storage and micturition reflex pathways. Currently, the most mature applications are detrusor electrical stimulation and pots. Surgical treatment of nerve reflexes is further reduced by electric stimulation of the sciatic nerve and interstimal stimulation of the sacral nerve root. However, surgical treatment has not been completely replaced by the above treatment. For different cases, bladder neck incision, extraurethral sphincterotomy, pudendal nerve sphincter, artificial urethral sphincter can be used. Severe lesions, urinary function has no hope of recovery, existing or potential upper urinary tract damage, etc., have to use urinary diversion surgery, and even permanent cystostomy. Treatment of diseases: stress incontinence Indication 1. Urgent urinary incontinence or urgency-urinary frequency syndrome caused by upper motor neuron lesions, drug therapy and sacral nerve block. 2. Unexplained urgency incontinence or urgency-urinary frequency syndrome, ineffective by non-surgical therapy. Contraindications 1. Urgent urinary incontinence or urgency-urinary frequency syndrome caused by local factors of the bladder and urethra, such as cystitis, bladder stones, bladder tumors, etc. 2. Combined with urinary tract obstruction below the bladder. Preoperative preparation A catheter is placed in the urethra before surgery. Surgical procedure 1. Incision The midline incision in the lower abdomen 2. After the free bladder reveals the bladder, push the peritoneum up, free the posterior part of the bladder top, or cut the peritoneum, retain the part of the peritoneum covering the bladder, and then close the abdominal cavity. Continue to free the posterior wall of the bladder to the bladder neck. 3. Free ureter will separate the ureters and free. The bilateral posterior ligaments were cut along both sides of the bladder wall and ligated throughout, including the superior bladder and its branches. Continue to free the ureter to the bladder. 4. Place a drainage tube or rubber band to drain the drainage posterior pubic space. The urethra is indwelling the balloon catheter. complication 1. It is necessary to prevent damage when the ureter is free. If there is damage, it should be handled properly in time. 2. The part of the bladder nerve cut is better with the closer to the bladder. If the cut site is far from the bladder, it will not only have poor efficacy, but also affect the function of other muscles.

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