Clinical Therapy And Recovery Training Of Overactive Neurogenic Incontinence

Background and purpose:neurogenic bladder is neurogenic bladder urethra dysfunction caused by the injury of nerve system that modulate and control the voiding physiologic activity, and neurogenic urine incontinence is the major symptom of neurogenic bladder. This disease can generate urinary infection, vesical-ureter reflux, et a/.Renal failure is mainly held responsible for the death of this kind of patients. Neurogenic bladder is mainly caused by myelomeningocele in pediatrics surgery. According to the result of urodynamics neurogenic bladder can be divided into two groups roveractive neurogenic urine incontinence and low reflect neurogenic urine incontinence. The former is refered to neurogenic urine incontinence, which has more than 15cmH2O detrusor contraction in the bladder filling stage, and the latter is refered to neurogenic urine incontinence that has no detrusor contraction in voiding stage. The urodynamics and image results show that the patient with overactive neurogenic incontinence has low capacity, pelvic floor ptosis, low compliance and more than 15cmH2O detrusor contraction in the bladder filling stage. The therapy of neurogenic urine incontinenceshould follow the undermentioned principals: treat the primary affection first which is curable and protect the urethra function at the same time. As for the primary affection that is incurable the treatment should be processed according to the type of the urethra dysfunction. Other treatments to prevent and cure upper-urethra tract complications can improve living quality. The treatment of neurogenic bladder is still a difficulty medically. The study is to discuss the roles of operation surgery and recovery training in the treatment of overactive neurogenic urine incontinence, and evaluate the treatment effect through patient following-up. Method:Using operation surgery and recovery training we have treated 82 patients with overactive neurogenic urine incontinence since 1992. We selected operation principal according to the results of urodynimics and image examination as follows:(1)For the patients with low bladder capacity, bladder augmentation was processed by using the patch of ileal soromusculor separated from mucosa . The soromusculor of 20 cm -40cm ileum chosen was circlewise sundered and the mucosa was removed. The patch of ileal soromusculor separated from mucosa was obtained by using the material just mentioned above. This kind of patch was sutured with the bladder dissected vertically to augment the bladder capacity and increase the compliance(2) The patients of overactive neurogenic urine incontinence with pelvic floor ptosis was undergone pelvic floor strengthening by using the iliopsoas at the same time. The bilateral iliopsoas tendons were amputated at the thighbone lesser trochanter and drawn out in pelvic cavity , and two ends were sutured together with the ptotic pelvic floor .?The patients with genuine stress incontinence were processed bladder neck suspending with pyramidal muscle. Bilateral pyramidal muscles were separated and fixed to the opposite pubic tubercle round the bladder neck.@Postoperatively the patients were received recovery training as follows :Bladder function drill, micturition reflect drill and pelvic floor muscle drill. The patients with overactive neurogenic incontinence who have undergone operation surgery since 1992 were followed-up by using telephone questionnaire. There were 28 patients whose preoperative and postoperative urodynamics results were complete. The results were analysed by SPSS510.0 statistical software, and a equals 0.05 were considered significant test level. Results:There was no auto-micturition observed in any of the 28 patients and the micturition were carried out through enhancing abdominal stress. In 10 of 28 patients (36%) the interval between voiding was longer than 2.5 hours, the time was from 1 to 2.5 hours in 13 patients (46%), and it was shorter than 1 hour in 5 patients (18%). In addition ,there were 18 patients (78%,23 patients had no micturition desire) received mic...