uninhibited neurogenic bladder: uncontrolled contractions lead to frequency, urgency, urge incontinence, assc. w/ CVA, tumor, cerebral palsy, dementia, MS
reflex uninhibited: phasic uninhibited contractions triggered by something, may be incomplete, from suprasacral cord lesion from trauma, tumor, MS.
Detrusor sphincter dyssynergia: high T or C spine injury, no sensation of filling but will get sweating, headache, HTN, spasms when full
Autonomic neurogenic bladder: no efficient detrusor contractions, must increase intraabdominal pressure to void. PVR is large. From damage to sacral cord, conus medularis, cauda equine, sacral plexus trauma, myelomeningocele, pelvic surgery
Sensory neurogenic bladder: no sensation, no detrusor hyperreflexia, larc capacity. Tabes dorsalis, diabetes, syringomyelia, pernicious anemia.
Motor paralytic bladder: rare, no detrusor fxn, normal sensation, normal capacity. Polio, trauma, meningomyelocele, congenital.
Urodynamics (listed above) plus renal ultrasound, and creatinine
Anticholinergics to relax detrusor
Intermittent catheterization- less infection than chronic indwelling
Sphincterotomy- cut the sphincter, created incontinence but protects kidney from high pressure backup
5th most common cancer in Americans, more common in men
Assc. with smoking, rubber and oil refinery work
85-90% transitional cell
Adenocarcinomas assc with patent urachus and bladder dome
Squamous cell assc with schistosomiasis, indwelling foley, chronic inflammation
Hematuria, irritative voiding symptoms, imaging, cytology
Staged by depth:
T1a: no invasion of bm
T1b: in situ
T2: superficial detrusor invasion
T3: deep muscle, perivesicle fat
T4: adjacent organ involved
T1: transurethral resection
Recurrence rate is 50% and requires intravesicle chemo: thiotepa, bacillus calmette-guerin, mitomycin-C
Patients are at risk for cancers in other parts of the urinary system, need cystoscopy and cytology every 3-4 mo for first 1-2 yrs.
For invasive tumors: cystectomy is required. For men remove bladder, prostate, perivesical fat, and pelvic lymph nodes. For women remove bladder, anterior vaginal wall, uterus, and lymph nodes. 5 yr survival is 60% for cystectomy post T3 cancer.
When you remove the bladder you need to either divert urine to the skin using an ileal conduit made of colon or you can make a bladder pouch out of bowel that connects to the urethra which avoids the need for cutaneous diversion.