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[Neurogenic urethra. Urethrogram and pathophysiological aspects].

H Madersbacher

    Fortschritte Der Medizin
    |February 17, 1977
    PubMed
    Summary
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    Neurogenic bladder dysfunction often involves the posterior urethra and pelvic floor, not just the bladder. Addressing urethral and pelvic floor issues is key to improving urinary voiding in these patients.

    Area of Science:

    • Urology
    • Neurogenic bladder dysfunction
    • Pelvic floor disorders

    Background:

    • Neurogenic urinary voiding disturbances are often attributed solely to bladder issues.
    • The role of the posterior urethra and pelvic floor muscles in these disturbances is frequently overlooked.

    Purpose of the Study:

    • To investigate the functional disturbances of the posterior urethra and pelvic floor in neurogenic urinary voiding.
    • To correlate radiological findings with urodynamic data for a comprehensive understanding.

    Main Methods:

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

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    Main Results:

    • Specific urethral shape changes characterize different neurogenic bladder types.
    • Urethral contour changes correlate with disease duration and secondary morphological changes in the prostate and seminal vesicles.
    • Functional obstruction at the spastic or paretic pelvic floor level was identified.
    • Roentgenologically visible posterior urethral deformation significantly impacts urinary voiding, causing low urinary performance despite adequate bladder pressure.

    Conclusions:

    • Posterior urethral and pelvic floor abnormalities are critical in neurogenic bladder voiding disturbances.
    • Improving urinary performance necessitates reducing expulsion resistance, often through surgical intervention.
    • Therapeutic strategies should focus on addressing urethral and pelvic floor obstructions.