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neurogenic bladder Its causes, diagnosis, and modern treatment with medicine or with Botox injections

Neurogenic bladder is a disease that affects the bladder as a result of a pathological defect or as a result of neurological diseases or chronic inflammatory diseases, and the latter is more prevalent in women than men.

the definition:

Neurogenic bladder is defined as a pathological condition that affects the bladder after exposure to chronic infections or accidental exposure of the spinal cord to an accident that completely or partially damages it, or the patient has multiple sclerosis, and these diseases pathologically lead to an increase in the production of the neurotransmitter (acetylcholine), which It is secreted from the parasympathetic nerves on a regular basis, but in the case of an increase in its percentage in the bladder wall, it leads to stimulating the neuromuscarinic receptors and the neurotransmitter to the brain, causing superior activity of the bladder muscles and leading to urge incontinence and urine leakage without warning, as well as leading to the sudden and urgent feeling of emptying the bladder before it is physiologically full (400-300 mm) in urine.

The recent pathophysiological background of the causes of high activity of the bladder muscle has indicated the presence of multifaceted pathological factors, namely:

Neurological cause: It is either due to super excitability coming from the urination center in the brain (Pentium), or it is due to the loss of vesical suppression in these upper central areas, as is the case in neurological diseases such as MS, due to the loss of physiological inhibition on the bladder, leading It leads to high activity in it with an extraordinary contraction of the bladder muscle, and this is also diagnosed in the case of injury to the spinal cord, resulting in accidental injury to these patients.

To a decrease in the central cerebral depression of the bladder, causing an increase in excitability, causing the formation of reflexes stimulating the nerve fibers (syn) of the bladder leading to the same pathological changes of the hyperactive neurogenic bladder.

2- Muscular cause: Recent studies have shown that changes in the sensitivity of the bladder to stimulant substances present in urine are the cause that leads to neurogenic bladder.

As this elevated sensitivity leads over time to changes within the bladder cells, causing the production of a surface protein within the muscarinic receptors and then leading to a hyperactive neurogenic bladder.

3- Bladder cell cause: In the bladder there are endothelial cells, which are the barrier between the stored urine and the muscular wall of the bladder. In this region of the bladder there is a dense amount of terminal nerves, as well as stromal cells whose effect lies in the organized rhythmic arousal in the bladder. If a pathological imbalance occurs For these cells, through these three types of cells in the bladder (endothelial cells, muscle cells and stromal cells), the bladder acquires a feeling of fullness early, leading to contraction and then emptying of urine without prior warning.

4- The cause of the diversity of cellular materials: The various cellular materials in the bladder (muscular, nervous, stromal and membranous) may lead to a change that occurs in the normal physiology of the bladder, causing hyper-excitation leading to bladder muscle spasm.

The effect of Botox on the nerve endings:

Effect of Botox (the neurotoxin extracted from Basil botulinum) After we dealt with the pathological causes that lead to the highly effective activity of the bladder, it is necessary to explain to the reader how this substance affects the complex cellular complex in the body in general and the bladder in particular in order to understand how this substance works to restore Physiological functions and normal sensitivity of the bladder during filling with urine to its normal state.

After treating the bladder with this substance by injection into its wall, the following happens:

  1. Partial changes in the mechanics of the vesicular nerves transmitting to the higher nervous center.
    Reducing the sensitivity of the bladder receptors.
    Reducing nerve sensitivity in the bladder membrane.
    Blocking the secretion of choline whose primary physiological function is the contraction of the bladder muscle to empty urine after it is secreted from the parasympathetic nervous system and the vesical muscle.
    Decreased indirect peripheral nerve sensitivity by decreasing central sensitivity leads to the reduction of chronic pain in the bladder, but does not affect acute pain in the bladder.

Laparoscopic image showing Botox injection into the bladder

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