Clinical aspects and therapeutic possibilities of neurogenic bladder

Osszefoglalo. Az also hugyutak fő funkcioja a vizelet tarolasa es uritese, amely műkodesek zavara az ugynevezett also hugyuti tunetegyuttes kialakulasahoz vezet, ami a kivalto oktol fuggően vizeleturitesi zavarral es vizeletretencioval is jarhat. Kezeletlen esetekben a felső hugyutak karosodasa kovetkezik be a magas holyagnyomas altal kivaltott vesicoureteralis reflux kovetkezteben, amely ureter- es veseuregrendszeri tagulat kialakulasara, illetve fertőzesekre es kőkepződesre hajlamosit. A vizelettarolasi/vizeleturitesi zavarokat harom fő csoportba sorolhatjuk, ugymint stressz- (terheleses) inkontinencia , hiperaktiv holyag (nedves/szaraz) es neurogen holyag. A jelen osszefoglalo kozlemeny targyat kepező neurogen holyag egy gyűjtőfogalom, mely magaban foglal minden, relevans neurologiai korkep talajan kialakult vizelettarolasi es vizeleturitesi zavart. Mivel a hugyholyag mellett a zaroizomzat es a hatso hugycső is erintett, ezt a korkepet napjainkban "neurogen also hugyuti diszfunkcio" elnevezessel is szokas illetni. A korallapotot a neurologiai diszfunkciok szeles spektruma okozhatja, kezdve a helyi funkcionalis zavartol a helyi idegi serulesen at a felső es also motoneuron-serulesig vagy a centralis degenerativ folyamatokig. Az elterő etiologia ellenere a klinikai tunetek rendszerint ket alapvető klinikai tipusban manifesztalodhatnak: tulműkodő (fokozott detrusorkontraktilitast okozo automata) holyag vagy alulműkodő holyag formajaban. Tekintettel a neurogen also hugyuti diszfunkcio kovetkezteben letrejovő felső hugyuti komplikaciokra, a kozlemeny egyik celja a betegseg diagnozisat segitő algoritmus bemutatasa a legujabb nemzetkozi szakirodalmi ismeretek alapjan. A neurogen holyag kezelese jobbara nem terjedhet ki a kivalto ok kezelesere, ezert a jelen osszefoglalo masik celja azon gyogyszeres es invaziv terapias beavatkozasok osszefoglalasa, melyek a felső hugyutak vedelmet szolgaljak az alacsony holyagnyomas fenntartasa reven. Orv Hetil. 2021; 162(4): 135-143. Summary. Storage and urination are the main functions of the lower urinary tract and its lesions lead to the so-called lower urinary tract syndrome causing either urinary incontinence or retention. In untreated cases, the upper urinary tract becomes injured via a vesicoureteral reflux resulting from increased bladder pressure and resultant dilations of the ureter and the renal pelvis which predispose to infection and stone formation. Lower urinary tract storage/urination disorders can be classified as stress incontinence, hyperactive bladder (wet/dry) and neurogenic bladder. Neurogenic bladder which is the subject of this review, is a collective term that encompasses all urinary storage and emptying disorders which develop on the basis of neurological diseases. Being not only the bladder, but also the sphincter and posterior urethra (generally termed as the "bladder outlet") affected, nowadays this condition is referred to as "neurogenic lower urinary tract dysfunction". A wide range of neurological dysfunctions could contribute to the development of this condition, ranging from local dysfunction (autonomic dysreflexia) or local nerve injury to upper/lower motoneuron injury or central degenerative processes. Regardless of the diverse etiology, the clinical symptoms eventually manifest in two major forms, i.e., overacting (automatic bladder with increased detrusor contractility) and underactive bladder. Considering the severity of complication occurring in the upper urinary tract in response to the pathophysiological changes in the lower urinary tract, one of the aims of this paper was to present an algorithm aiming to build up a state of the art diagnosis of the disease based on current international literature data. Since treatment of the neurogenic bladder usually can not target elimination of the underlying cause, the other goal of the present paper is to summarize the pharmacological treatment regimen and invasive therapeutic interventions that protect the upper urinary tract by maintaining low pressure values in the bladder. Orv Hetil. 2021; 162(4): 135-143.