Cystometry

Cystometry gives the opportunity to receive information on the relationship intravesical pressure and capacity of the bladder in the period of its content, the sensitivity of its walls, functional state of the detrusor. Cystometry used in clinical practice for the last 50 years, but has been widely used in recent years in connection with improvement of the techniques and methods this study, new data on morphology and function of the detrusor.

Research methodology. Before the study offer the patient to urinate, and at this time you can run uroflowmetry. Then kateteriziruyut bladder; the outer part of the catheter attached to cystometry and bubble injected isotonic solution of sodium chloride or carbon dioxide. On cystogram noted the appearance of the first urge to urination. Naturally need to occur with the introduction of 150 - 250 ml of liquid. In subsequent on sistematicheskoe curve marked maximum sistematicheski volume of the bladder, which coincides with the maximum intensity of the urge to urinate. With the rapid filling cystometry (more than 100 ml/min), the maximum sistematicheski volume bladder equal to 2/3 of the volume of the bubble, registered at water cystometry. After reaching the maximum sistematicheskogo volume introduction of liquid or gas the bladder stop. The reduction of the detrusor at its normal functions can be hampered by the strong-willed voltage for 50 C. In this period is often necessary to use provocative tests for activated detrusor. This is because many patients delusory reflex is possible only in a vertical position, at walking on the spot or Bouncing. Activation detrusor reflex by changing the position of the body due to secondary excitation pool motor neurons of the detrusor in the side horns gray matter of the sacral spinal cord on the background of stimulation postural reflexes. After conducting provocative tests, the patient is allowed to urinate. In this period urinating on cystogram a gradual rise of the pressure curve, corresponding to a reduction of the detrusor. Upon reaching the maximum amplitude curve detrusor contractions again suppressed by an effort of will. After that the bladder is empty.

Cystometry allows to characterize the functional state of the detrusor, to determine the amount of residual urine, intravesical pressure, maximum sistematicheski volume of the bladder and to establish the relationship between the volume of the bubble and the pressure in it. Under physiological conditions bladder adapts to increase their volume increased intravesical pressure. When cystometry function detrusor during urination is expressed in terms of intravesical pressure. Normotimicescoe state detrusor corresponds 6,7 - to 9.3 kPa (50 - 70 mm RT. century), hypertensive - 10,7-14,6 kPa (80-110 mm RT. century), and hypotonic - 1,3 -5,3 kPa (10 - 40 mm RT. Art.). Proprioreceptors detrusor and exteroreceptors the bladder mucosa ensure the emergence of the first urge to urination during the filling volume of the bubble 150 - 250 ml, and in the further introduction of liquid appear imperative urge. Under physiological conditions in most healthy men retained the ability of braking detrusor contractions in the range of maximum sistematicheskogo bladder volume. Citometria identified pathological changes neuromuscular mechanism detrusor - detruzora hyperreflexia and detruzora areflexia. The emergence detrusor reflex in a small bladder filling (50-200 ml), which is not hampered by an effort of will, is called detrusor hyperreflexia. However, the feeling of the first urge to urinate occurs already at the minimum volume put into the blister fluid, and after that quickly becomes an imperative need in connection with serial detrusor contractions.
On cystogram detruzora hyperreflexia characterized by recurrent waves of high amplitude with gradual attenuation due to depletion detrusor reflex. Detruzora hyperreflexia occurs when a number of neurological diseases in connection with violation of innervation of the detrusor on supraspinatus level (multiple sclerosis, Parkinson's disease, acute violation of cerebral circulation). In the basis of pathophysiological mechanism detruzora of hyperreflexia with organic diseases Central nervous system is the reduction of cortical and hypothalamic inhibitory effect on the spinal centers, regulatory urination. This will disturb the balance between the flow of afferent impulses from the bladder into the spinal cord and their braking Central governing the links of the nervous system. As for the mechanism detruzora of hyperreflexia in patients with adenoma of the prostate gland, then the process is probably due to the change in the activity of the detrusor against adrenergic effects, and also determines the previous functional state muscles (neurogenic disorders detrusor-sphincter apparatus, injury, pathological processes in the field of cystic-urethral segment, dystonia bladder neck). Pathogenesis detruzora of hyperreflexia in the development infravesical obstruction in patients with prostate adenoma associated with lower threshold reflex stretch the bladder wall with the weakening of the contractile properties hypertrophied detrusor. In this process played the role of changes in the Central nervous system in men, elderly and senile age, constituting the bulk of patients with adenoma prostate gland. In connection with hemodynamic disturbances in cerebral cortex and subcortical structures is the weakening of the braking process spinal centers urination that the high sensitivity of the detrusor to the changing conditions of urodynamics creates conditions for detruzora of hyperreflexia. Practically important early recognition detruzora of hyperreflexia to select the correct treatment tactics, because the detrusor instability greatly impairs functional results of adenomektomii. After adenomektomii unstable detrusor clinically manifested imperative craving, mandatory urine incontinence. Detruzora areflexia characterized by the absence of signs of detrusor contractions when sistematicheskom study using provocative tests and occurs when the violation of the corresponding innervation of the detrusor (spinal cord injury, tumors of the cone of the spinal cord, diabetic myelopathy). Detruzora areflexia should be distinguished from psychogenic inhibit the activity of detrusor reflex due to discomfort in the period cystometry. In such cases, simultaneous recording of bioelectric activity of striated muscles of the external sphincter of the bladder will clarify the diagnosis. In psychogenic inhibition of detrusor reflex remains normal bladder sensation in the stage of filling. Thus on EM G-curve has increased, bioelectrical activity of the external sphincter and muscles of the pelvic floor, inhibiting the urge to urinate. In severe degree infravesical obstruction in patients with BPH in connection with decompensation of the detrusor, a decrease of sensitivity of the bladder wall and a violation of neuromuscular transmission of impulses to detruzora may experience his areflexia. One of the important sistematicheskij indicators in the development infravesical obstruction due to prostatic hypertrophy is the state of muscle bladder or give its walls to stretch in the stage of filling. The malleability of the walls of the bladder to stretch is determined by the ratio of its volume in the period of filling and intravesical pressure, and also depends on the elasticity of the detrusor. The degree of compliance of the walls of the bladder to stretch reduced during long drainage catheter, fibrosis of the detrusor, chronic cystitis. In patients with prostate adenoma in the development infravesical obstruction using cystometry can be revealed changes in the degree of compliance of the bladder to stretch. With a high degree of flexibility (hypertonic the bladder) the first urge to urinate occurs later than normal, intravesical pressure low, and the maximum sistematicheski volume increases significantly (up to 800 ml), i.e. the imperative need arise with the increased volume of urine in the bladder. At low grade compliance (hypotonicity the bladder) the first urge to urinate occurs earlier than normal, with subsequent gradual increase intravesical pressure at a reduced maximum sistematicheskom volume. Thus, the development infravesical obstruction in patients with BPH reflects the characteristic changes in zitohroma, allowing to identify certain types of bladder dysfunction. Of practical importance is timely detection detruzora of hyperreflexia (detrusor instability, which occurs in 50% of patients with infravesical obstruction associated with the development of benign prostatic hyperplasia.