Detrusor hyperreflexia

Introduction Overactive bladder (OAB) is a common disease, pons and intermedullary lesions, often manifested as detrusor hyperreflexia plus detrusor external sphincter dyssynergia, characterized by urgency, with or without urgency Urinary incontinence, often accompanied by frequent urination and nocturia. The Chinese Medical Association Urology Branch Urinary Control Group "Clinical Guiding Principles of Overactive Bladder" is defined as: OAB is a syndrome consisting of frequent urination, urgency, and urge incontinence. These symptoms can occur alone or in any combination. The form appears. During urodynamic examination, some patients in the bladder storage period, the bladder detrusor involuntary contraction, causing an increase in intravesical pressure, called detrusor overactivity. The two are both connected and different.

Cause

The symptoms of OAB are caused by the involuntary contraction of the detrusor during bladder filling. The cause is still not well understood. It may be due to central inhibitory efferent pathway, peripheral sensory afferent pathway or damage to bladder muscle itself. These reasons can exist individually or in combination.

The central nervous system of the pons has a major inhibitory effect on micturition reflex, where lesions often lead to insufficient inhibition, and the incidence of detrusor hyperreflexia is 75% to 100%, generally without the detrusor external sphincter synergistic disorder; - Intermedullary lesions, mostly manifested as detrusor hyperreflexia plus detrusor external sphincter synergy. Diabetes and other causes of periorbital neuropathy, there are reports of detrusor hyperreflexia, which may be related to the multifocality of the lesion. In addition, the incidence of unstable bladder caused by bladder outlet obstruction is as high as 50% to 80%. It changes through the nerves and muscles of the bladder wall, eventually causing an increase in detrusor excitability and OAB symptoms.

an examination

Related inspection

Urine routine r-sperm protein assay (r-sm)

The focus of the physical examination is on the abdomen, pelvis, rectum, and nervous system. Urine routine examination is a must, if it is positive, further bacteriology, cytology and other tests are required. For residual urine measurement after urination, urodynamic examination, etc., it should be selectively applied according to the patient's condition. After the pathological conditions such as infection, stone, and bladder cancer in situ are excluded, the diagnosis of overactive bladder can be made.

Differential diagnosis

OAB is an empirical diagnosis using the definition of ICS or urinary control group. It is important to ask about your medical history carefully, including typical symptoms and related symptoms. The history of medical records should cover the history of diagnosis and treatment of medical, neurological and genitourinary diseases and treatment outcomes. At the same time, a detailed urination diary is required and a targeted questionnaire is conducted.

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