WordNet

a bag that fills with air
a distensible membranous sac (usually containing liquid or gas) (同)vesica
arising in or stimulated by nerve tissues

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(人間・動物の)襄(のう),ぼうこう,(魚の)浮き袋;気胞　嚢に似た物

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/12/22 15:27:48」(JST)

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Neurogenic bladder dysfunction, sometimes simply referred to as neurogenic bladder, is a dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of micturition (urination).

Causes[edit]

Neurogenic bladder is often associated with spinal cord diseases (such as Syringomyelia/Hydromyelia), injuries, and neural tube defects including spina bifida. It may also be caused by brain tumors and other diseases of the brain, and by peripheral nerve diseases. It is a common complication of major surgery in the pelvis, such as for removal of sacrococcygeal teratoma and other tumors.

Treatments[edit]

Neurogenic bladder usually causes difficulty or full inability to pass urine without use of a catheter or other method. Catheterization methods range from intermittent catheterization, which involves no surgery or permanenty attached appliances, to the creation of a stoma, which bypasses the urethra to empty the bladder directly.

Intermittent catheterization is the use, several times a day, of straight catheters (which are usually disposable or single-use products) to empty the bladder. This can be done independently by the patient, or with help, in the case that the patient lacks the dexterity to manage the catheter.

For patients that are unable to tolerate disposable straight catheters, the use of a Foley Catheter is used to allow continuous drainage of urine into a sterile drainage bag that is worn by the patient.

Other treatments involve creation of a stoma that is continent and readily accepts a catheter. These are known as Mitrofanoff mechanisms. An example of this treatment is the creation of an Indiana pouch. Additionally, a muscarinic agonist like Bethanechol may also be used, particularly in the postpartum or postoperative period.

Function of the stoma may be augmented by periodic injections of botulinum toxin to relax one of the two sphincters involved in normal urination.^[1] The effect is longer lasting with botulinum toxin type A than with type B.^[2] This use of botulinum toxin is discussed at length in the French medical literature.^[3]^[4]^[5]^[6]^[7]

References[edit]

^ Akbar M, Abel R, Seyler TM, Gerner HJ, Möhring K (2007). "Repeated botulinum-A toxin injections in the treatment of myelodysplastic children and patients with spinal cord injuries with neurogenic bladder dysfunction". BJU Int. 100 (3): 639–45. doi:10.1111/j.1464-410X.2007.06977.x. PMID 17532858.
^ Hirst GR, Watkins AJ, Guerrero K, Wareham K, Emery SJ, Jones DR, Lucas MG (2007). "Botulinum toxin B is not an effective treatment of refractory overactive bladder". Urology 69 (1): 69–73. doi:10.1016/j.urology.2006.09.005. PMID 17270619.
^ Game X, Karsenty G, Chartier-Kastler E, Ruffion A (2007). "[Treatment of neurogenic detrusor hyperactivity: enterocystoplasty]". Prog. Urol. (in French) 17 (3): 584–96. doi:10.1016/S1166-7087(07)92373-8. PMID 17622095.
^ Karsenty G, Corcos J, Schurch B, Ruffion A, Chartier-Kastler E (2007). "[Pharmacological treatment of neurogenic detrusor hyperactivity: intradetrusor botulinum toxin A injections]". Prog. Urol. (in French) 17 (3): 568–75. doi:10.1016/S1166-7087(07)92370-2. PMID 17622092.
^ Chartier-Kastler E, Ruffion A (2007). "[Treatment of vesicoureteric reflux and neurogenic bladder]". Prog. Urol. (in French) 17 (3): 470–2. PMID 17622079.
^ Chartier-Kastler E, Comperat E, Ruffion A (2007). "[Disorders of bladder compliance and neurogenic bladder]". Prog. Urol. (in French) 17 (3): 442–7. PMID 17622074.
^ Chenet A, Perrouin-Verbe B, Le Normand L, Labat JJ, Brunel P, Lefort M, Mathé JF (2007). "[Efficacy of repeat injections of botulinum A toxin to the detrusor in neurogenic bladder overactivity.]". Annales de Réadaptation et de Médecine Physique 50 (8): 651–60. doi:10.1016/j.annrmp.2007.03.019. PMID 17490775.

UpToDate Contents

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1. 脊髄損傷および疾患の慢性合併症 chronic complications of spinal cord injury and disease
2. 小児における膀胱機能障害の病因および臨床的特徴 etiology and clinical features of bladder dysfunction in children
3. 小児における膀胱機能障害の評価および診断 evaluation and diagnosis of bladder dysfunction in children
4. 小児における膀胱機能障害のマネージメント management of bladder dysfunction in children
5. 成人における多発性硬化症の臨床的特徴 clinical features of multiple sclerosis in adults

English Journal

Clinical profile of motor neuron disease patients with lower urinary tract symptoms and neurogenic bladder.

Vázquez-Costa JF1, Arlandis S2, Hervas D3, Martínez-Cuenca E2, Cardona F4, Pérez-Tur J4, Broseta E2, Sevilla T5.
Journal of the neurological sciences.J Neurol Sci.2017 Jul 15;378:130-136. doi: 10.1016/j.jns.2017.04.053. Epub 2017 May 2.
PMID 28566149

A cross-sectional study of the catheter management of neurogenic bladder after traumatic spinal cord injury.

Lane GI1,2, Driscoll A1, Tawfik K3, Chrouser K1,2.
Neurourology and urodynamics.Neurourol Urodyn.2017 Jun 5. doi: 10.1002/nau.23306. [Epub ahead of print]
PMID 28580635

Clinical characteristics of bladder cancer in patients with spinal cord injury: the experience from a single centre.

Böthig R1, Kurze I2, Fiebag K3, Kaufmann A4, Schöps W5, Kadhum T6, Zellner M7, Golka K6.
International urology and nephrology.Int Urol Nephrol.2017 Jun;49(6):983-994. doi: 10.1007/s11255-017-1570-6. Epub 2017 Mar 22.
PMID 28332134

Japanese Journal

神経原性腫瘍が疑われ, 診断に苦慮した骨盤内悪性リンパ腫の1例

惣田哲次,奥見雅由,宮川康,中紀文,辻村晃,野々村祝夫
泌尿器科紀要 59(5), 293-296, 2013-05-00
… Pelvic magnetic resonance imaging (MRI) revealed a mass 6 cm in diameter immediately next to the left side of the bladder. … Under a diagnosis of neurogenic tumor, surgery was performed. …
NAID 120005245085

神経疾患に伴う過活動膀胱(OAB)と認知機能に対するイミダフェナシンの安全性と効果

榊原隆次,舘野冬樹,矢野仁 [他]
臨床泌尿器科 66(10), 775-781, 2012-09-00
NAID 40019424264

Neurogenic bladder due to a tethered spinal cord

CHOI Joon Seok,PARK Jeong Woo,KIM Soo Wan
Clinical and experimental nephrology 16(4), 652-653, 2012-08-01
NAID 10031058411

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★リンクテーブル★

リンク元	「神経因性膀胱」「neurogenic urinary bladder」「過敏膀胱」「過敏性膀胱」
拡張検索	「autonomous neurogenic bladder」「congenital neurogenic bladder」
関連記事	「neurogenic」「bladder」

「神経因性膀胱」

Neurogenic bladder
	Classification and external resources
ICD-10	N31.9
ICD-9	596.54
DiseasesDB	30837
MedlinePlus	000754
eMedicine	med/3176
MeSH	D001750

　　[★]

英: neurogenic bladder
ラ: vesica neurogena
同: 神経原性膀胱、神経障害膀胱 neuropathic bladder
関: 排尿筋、neurogenic urinary bladder

概念

神経系に生じた障害により生じる蓄尿・排尿障害

分類

神経因性膀胱

IMD SURO.164

橋排尿中枢より上位の障害	脳血管障害(脳出血、脳梗塞)、パーキンソン病、認知症、脳外傷、脳腫瘍	[橋排尿中枢への抑制が失わる]蓄尿による求心性知覚線維(Aδ)の興奮→(中枢より抑制を受けず)PMCによる排尿指令→仙髄副交感神経中枢による排尿指令→排尿筋収縮	蓄尿障害(排尿筋不随意収縮、切迫尿失禁、頻尿)
核上脊髄障害	脊髄損傷、多発性硬化症、損傷部位に依存して後縦靭帯骨化症、二分脊椎、HAMでも起こる	[異常な排尿回路の形成]蓄尿による求心性知覚線維(C)の興奮→(C線維による2つの異常な回路が形成され、求心性知覚情報はここに入力)(1)仙髄副交感神経中枢による排尿指令、(2)オヌフ核による外尿道筋収縮→排尿筋収縮＋外尿道筋収縮	蓄尿障害(反射性尿失禁)、排尿障害(排尿筋括約筋協調不全)
仙髄より下位の神経障害	下位脊髄損傷、仙髄以下馬尾神経の障害をきたす二分脊椎、脊髄稽留症候群、腰部脊柱管狭窄症、下位の損傷を起こすような後縦人口骨化症、シャイ・ドレガー症候群、脊髄小脳変性症、多発性硬化症、脊髄癆、HAM		排尿障害、残尿、尿閉