桥脑排尿中枢PONS

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1、PeripheralNeuropathyandNeurogenicVoidingDysfunctionHann-ChorngKuoDepartmentofUrologyBuddhistTzuChiGeneralHospitalPeripheralneuropathyCaudaequinasyndromeSacralrootinjuryPelvicplexusinjuryDiabetesneuropathyDetrusordenervationConsequencesofperipheralneuropathyDetrusorcontrac

2、tionsarelostBladderbecomesanacontractilesacBladderemptybyabdominalstrainingorsuprapubiccompression(Credemaneuver)orcatheterizationBladdersensationbecomesvagueLowerurinarytractsymptomsinPeripheralneuropathyDysuriaStrainingtovoidFrequencyResidualurinesensationUrinaryincontin

3、ence(overflow)UrinaryretentionPhysiologyofmicturition橋腦排尿中樞PONS胸腰髓T10-L2薦髓S2,3,4骨盆底神經陰部神經CaudaequinalesionLumbarspinalinjurySurgeryforherniateddiscCompleteorincompleteinjurytonerverootsDetrusorcontractilityislostincompletelesionRecoveryofdetrusorcontractilitydependsonsever

4、ityoflesionDiagnosisofCaudaequinalesionHistoryofsurgicaltraumaDysuriaandstrainingtovoidafterspinesurgeryConstipationistheruleSaddleanesthesiaorparesthesiaLowerextremitymotordeficiencyUrodynamicsofCaudaequinalesionDetrusorareflexiaatinitialstage,sphinctertoneisfixed(normalo

5、rweak)BladdersensationoffillingisnormalorvagueBladderneckmaybeclosedoropenBladdercomplianceisnormalinitiallyPatientsvoidbyabdominalstrainingDetrusorareflexiaaftercaudaequinalesionIsolatedsphincterobstructionincaudaequinalesionsBladderoutletinCaudaequinalesionBladderneckmay

6、beclosedduetolackofsynchronizedrelaxationduringvolitionalvoidingBenignprostaticenlargementmayincreaseurethralresistanceIsolatedstriatedurethralsphincterresultsinbladderoutletobstructionBladderoutletobstructionduetoBPHincaudaequinalesionPersistentdysuriaafterTURPincaudaequi

7、nalesionChronicLUTDafterCaudaequinalesionBladdercomplianceturnslowerthannormalBladdersensationremainsvagueInisolatedurethralsphincterobstructionthebladderneckisopenandtrabeculatedbladderdevelopsInlowurethralresistance,thebladdermaintainsalowpressurereservoirTrabeculatedand

8、poorcompliantbladderincaudaequinalesionsObstructiveuropathyinchroniccaudaequinalesionsMen