nonneurogenic neurogenic bladder


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non·neu·ro·gen·ic neu·ro·gen·ic blad·der

detrusor-sphincter incoordination with urinary incontinence, constipation, urinary tract infection, upper tract changes.
Synonym(s): Hinman syndrome

bladder

(blad'er)
A membranous sac or receptacle for a secretion, as the gallbladder; commonly used to designate the urinary bladder. See: urinary bladder; genitourinary system

autonomous bladder

A bladder in which there is interruption in both the afferent and efferent limbs of the reflex arcs. Bladder sensation is absent; dribbling is constant; residual urine amount is large.

cord bladder

Distention of the bladder without discomfort. Symptoms include a tendency to void frequently and dribbling after urination. The condition is caused by a lesion affecting the posterior roots of the spinal column at the level of bladder innervation above the sacrum.

fallen bladder

A colloquial term for a cystocele.

hypertonic bladder

1. A bladder with excessive muscle tone.
2. Increased muscular activity of the bladder.

irritable bladder

Bladder condition marked by increased frequency of contraction with an associated desire to urinate.

motor paralytic bladder

A neurogenic bladder caused by defective nerve supply to the bladder. In the acute form urination is not possible. In the chronic form there is difficulty in urinating, which may lead to recurrent urinary tract infections.

nervous bladder

A condition marked by the repeated desire to urinate, but doing so fails to empty the bladder.

neurogenic bladder

Any dysfunction of the urinary bladder caused by lesions of the central nervous system or nerves supplying the bladder.

nonneurogenic neurogenic bladder

See: Hinman syndrome

overactive bladder

A sudden, intense urge to urinate that may or may not lead to loss of urine (urinary incontinence).

pear-shaped bladder

The shape assumed by the urinary bladder when it undergoes extrinsic compression due to excess tissue in the pelvis. It causes include pelvic lipomatosis, pelvic hematoma, pelvic lymphadenopathy, extravasated urine, pelvic fluid collections, pelvic masses, bilateral iliac artery aneurysms, collateral vessels, and iliopsoas muscle hypertrophy .

spastic bladder

Neurogenic bladder due to complete transection of the spinal cord above the sacral segments.

urinary bladder

A muscular, membranous, distensible reservoir that holds urine situated in the pelvic cavity. It receives urine from the kidneys through the ureters and discharges it from the body through the urethra. See: urinary system

Anatomy

The bladder is situated in the anterior inferior portion of the pelvic cavity. In the female it lies in front of the anterior wall of the vagina and the uterus; in the male it lies in front of the rectum. The lower portion of the bladder, continuous with the urethra, is called the neck; its upper tip, connected with the umbilicus by the median umbilical ligament, is called the apex. The region between the openings of the two ureters and the urethra is the trigone. The wall of the bladder has three major layers. The mucous membrane lining is transitional epithelium. The middle layer is three sheets (longitudinal, circular, longitudinal) of smooth muscle, called the detrusor muscle. The outer layer on the superior surface is the visceral peritoneum; on the lateral and inferior surfaces it is areolar connective tissue. The bladder is supported by numerous ligaments; it is supplied with blood by the superior, middle, and inferior vesical arteries, and drained by numerous veins and lymphatics; and it is innervated by branches of the third and fourth sacral nerves by way of the hypogastric plexus.

The bladder has a normal storage capacity of 500 ml (about 16 oz) or more. In disease states it may be greatly distended. A frequent cause of distention of the bladder in older men is interference with urination due to hypertrophy of the prostate gland, which surrounds the urethra and neck of the bladder.

Physiology

An average of 40 to 50 oz (about 1.2 to 1.5 L) of urine is excreted in a 24-hr period, but this varies with the amount of fluid ingested and the amount lost through exhalation, sweat, and the bowels. Inability to empty the bladder is known as retention and may require catheterization. Sphincter muscles are part of the mechanism that controls retention within the bladder.

For patients who need help in managing bladder elimination problems there are a variety of options: indwelling urethral catheters, Kegel exercises, intermittent catheterization, suprapubic indwelling catheters, external collecting devices (urinals and specially designed bedpans), medications for promoting bladder emptying (such as bethanechol, phenoxybenzamine, diazepam, dantrolene, or baclofen), and medicines to promote bladder storage (such as imipramine, oxybutynin, propanthelene, pseudoephedrine, or phenylpropanolamine). For men, a condom designed to collect and contain urine is available. See: bladder training

The force of urination is much greater in a child than in an adult because in the child the bladder is more an abdominal organ than a pelvic one. The child's abdominal muscles help to expel the urine.

Examination

Palpation: The bladder cannot be palpated when empty. When full it appears as a tumor in the suprapubic region that is smooth and oval on palpation.

Percussion: When it is distended with urine, the rounded superior margin is easily made out by observing the tympanic sound of the intestines on one hand and dull sound of the bladder on the other.

Hinman,

Frank, Jr., U.S. urologist, 1915–.
Hinman syndrome - detrusor-sphincter incoordination. Synonym(s): nonneurogenic neurogenic bladder