Article

This series of articles for rehabilitation in practice aims to cover a knowledge
element of the rehabilitation medicine curriculum. Nevertheless they are intended
to be of interest to a multidisciplinary audience. The competency addressed in
this article is 'the trainee consistent demonstrates a knowledge of the
pathophysiology of various specific impairments including bladder dysfunction'
and 'management approaches for specific impairments including bladder
dysfunction'. The lower urinary tract (bladder and urethra) has two roles:
storage of urine and emptying at appropriate times. The optimal and coordinated
activity of the lower urinary tract is subject to a complex neural control which
involves all levels of the nervous system, from cortex to peripheral innervation.
The complexity of the neural control of lower urinary tract explains the high
prevalence of urinary disturbances in neurologic disease. Information obtained
from history taking and supplemented by use of a bladder diary forms the
cornerstone of evaluation. Ultrasonography is used to assess the degree of
incomplete bladder emptying, and for assessing the upper tracts. Urodynamic
tests, with or without simultaneous fluoroscopic monitoring, assess detrusor and
bladder outlet function and give fundamental information about detrusor pressure
and thus the risk factor for upper tract damage. Impaired emptying is most often
managed by clean intermittent self-catheterization and this should be initiated
if the post-void residual urine is greater than 100 mL or exceeds one third of
bladder capacity, or rarely if spontaneous voiding is dangerous due to high
detrusor pressure. Storage symptoms are most often managed using antimuscarinic
medications. Other options include desmopressin to reduce urine output or
intra-detrusor injection of botulinum toxin type A to reduce detrusor
overactivity. Understanding of the underlying mechanism of lower urinary tract
dysfunction is crucial for effective management.

Langue : ANGLAIS