CLINICAL ASPECTS AND TREATMENT OF NEUROGENIC BLADDER DISORDERS

Neurogenic disturbance of micturation is categorised as follows: 1. de trusor hyperreflexia with disinhibited bladder, emptying automatically but complete. 2. detrusor-sphincter-dyssynergia with reflex-like inco mplete miction and 3. the are-flexic detrusor vesicae with urine reten tion and bladder overdistension. To avoid nephropathy and urinary trac t infection regular miction restoring a low bladder pressure should be achieved. Therapy should also lead to continence. Drug therapy includ es anticholinergics to reduce detrusor activity, alpha-sympathicolytic s to attenuate sphincter-internus tonus and alpha-sympathomimetics in stress incontinence. Intermittent self-catheterisation, urinary draina ge by suprapubic catheter and exercises of pelvic diaphragm are also r ecommended besides drug therapy for treatment of neurogenic bladder dy sfunction in disorders like Parkinson's disease or multiple sclerosis.