Vescica neurogena
Table of Contents
Definizione
La vescica neurogena rientra tra i disturbi dello svuotamento della vescica dovuti a lesioni del sistema nervoso centrale o periferico.
Fisiopatologia
Fisiologia della minzione: la minzione è un atto complesso risultante dall’interazione di impulsi nervosi volontari e involontari. Il sistema di apertura e di chiusura della vescica è formato da diversi sfinteri muscolari che obbediscono a stimoli o a inibizioni dei loro recettori alfa e beta. Il sistema nervoso che comanda la vescica può essere leso a livello cerebrale, midollare o neuromuscolare periferico della vescica.
Lesione del sistema nervoso centrale: incidenti vascolari cerebrali, traumi cranici, sclerosi a placche.
Lesione midollare congenita: spina bifida, meningocele.
Lesione midollare acquisita:
- Trauma, paraplegia. Il centro della minzione si trova nei segmenti midollari S2-S4 che corrispondono anatomicamente all’altezza di D12-L1. Una lesione con sede al di sopra provoca una vescica” automatica” o “riflessa” che si svuota automaticamente quando è riempita. Una lesione che ha sede al di sotto causa una vescica neurogena ipotonica.
- Altre affezioni midollari: tabe, siringomielia tumori midollari, ernia discali, emorragie spinali.
Lesione del sistema nervoso periferico: polinevrite, megaciste.
Farmaci: i neurolettici e antidepressivi triciclici, i tranquillanti e gli anticolinergici possono alterare lo svuotamento della vescica.
Sintomi
- Vescica da shock: nei traumi midollari con paraplegia o tetraplegia, la vescica è sempre tonica durante le prime settimane. Esiste un’incontinenza urinaria da distensione della vescica.
- Vescica automatica (lesione al di sopra dei segmenti S2-S4): la vescica è ipertonica, la sua capacità è ridotta, l’incontinenza è causata da contrazioni involontarie della muscolatura vescicale. Il reflusso uretero-vescicale. con infezione urinaria è frequente.
- Vescica ipotonica (lesione al di sotto dei segmenti S2-S4): la capacità vescicale è aumentata; incontinenza per distensione della vescica;il riflesso bulbo cavernoso è assente.
Complicazioni
Le complicazioni della vescica neurogena sono: infezioni urinarie acute e croniche, litiasi renale e vescicale.
Diagnosi
La diagnosi del meccanismo fisiopatologico responsabile della vescica neurogenica esige oltre agli esami usuali (urografia endovenosa e uretrocistografia) esami specialistici:
- Cistografia
- Cistoscopia
- Cistometrografia
Terapia
- Misure generali: bevande abbondanti, dieta povera di calcio, attività fisica e alzarsi più presto possibile alla mattina per evitare la formazione di calcoli alle vie urinarie.
- Terapia e prevenzione delle infezioni urinarie.
- Misure specialistiche: la rieducazione della vescica, gli interventi urologici plastici vanno eseguiti da uno specialista di urologia o in un centro per paraplegici.
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