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[The neutropathic urethra: urethrogram and pathophysiologic aspects (author's transl)].

H Madersbacher

    Der Urologe. Ausg. A
    |January 1, 1976
    PubMed
    Summary
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    Neurologic urinary incontinence.

    Neurourology and urodynamics·2009

    Neurogenic bladder dysfunction is often caused by posterior urethra and pelvic floor issues, not just the bladder itself. Addressing expulsion resistance through interventions is key to improving urinary flow in these patients.

    Area of Science:

    • Urology
    • Neuro-urology
    • Radiology

    Background:

    • Neurogenic urinary voiding disturbances often receive disproportionate focus on the bladder, neglecting the posterior urethra and pelvic floor.
    • Understanding the interplay between the posterior urethra, pelvic floor, and bladder function is crucial for diagnosing and treating neurogenic voiding issues.

    Purpose of the Study:

    • To investigate the role of the posterior urethra and pelvic floor in neurogenic urinary voiding disturbances using contrast radiography and urodynamic studies.
    • To correlate radiological findings with urodynamic parameters to better comprehend functional obstructions in neurogenic bladders.

    Main Methods:

    • Contrast radiography of the urethra during injection and micturition in 143 trauma patients and 69 myelomeningocele patients.
    • Urodynamic investigations including uroflowmetry, simultaneous intravesical/intrarectal pressure, and pelvic floor EMG activity recordings.

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  • Correlation of radiological changes in the posterior urethra, prostate, and seminal vesicles with clinical presentation and urodynamic data.

    • Main Results:

    • Specific urethral deformities were observed in various neurogenic bladder types, correlating with disease duration and secondary morphologic changes.
    • Significantly lower urinary flow rates were recorded in patients with upper and lower motor neuron lesions compared to normals.
    • Functional obstruction at the level of spastic or paretic pelvic floors was demonstrated, with roentgenologically visible urethral deformation being a primary cause of poor urinary voiding despite adequate bladder pressure.

    Conclusions:

    • Deformation of the posterior urethra is a critical factor in unsatisfactory urinary voiding and low urinary performance in neurogenic bladder.
    • Improving urinary performance in neurogenic bladder necessitates reducing expulsion resistance, often requiring operative procedures for bladder outlet obstruction.
    • Combined radiological and urodynamic assessment is essential for comprehensive understanding and management of neurogenic urinary voiding disturbances.