Neurogenik Bladder

Neurogenic bladder is a term used to define bladder and urinary sphincter

malfunctioning that results from some change in the
central nervous system (CNS) and/or peripheral nervous system

Urodinamik
Indikasi
1. Voiding LUTS bothersome usia <50 th, >80 th; PVR >300 ml, Qmax >10 ml/s

2. Pertimbangan terapi invasif pasien dgn VV <150 ml

3. Gagal terapi invasif

4. Riw operasi radikal pada pelvis

5. Curiga buli neurogenik

Contraindication
Urodynamics should not be performed in the setting of a symptomatic urinary tract infection.
Urodynamics should be obtained to assist in further management of a patient’s lower urinary tract
symptoms.
VUR
DEF : Backflow of urine (retrograde) from the bladder to the ureter or kidney

1. Etiologi

- Primer = kelainan anatomis pada muara ureter, katup yg bermasalah

- Sekunder = bladder outlet obstruction

2.Pressure

- Low = fase storage sdh reflux saat bladder filling

- High = fase voiding baru reflux saat micturition

Pemeriksaannya melalui pemeriksaan VCUG

1. Reflux hingga ureter. HU tanpa HN

2. Reflux hingga sistem pelvikalises. HU - HN Gr 1

3. Reflux hingga ureter, pelvis renalis dan kalises. HU - HN Gr 2

4. Reflux hingga ureter, pelvis renalis dan kalises. HU - HN Gr 3

5. Reflux hingga ureter, pelvis renalis dan kalises.HU - HN Gr IV

VCUG Step

1. Foto polos

2. Pasang kateter dan masukkan kontras ke buli lewat kateter hingga vol buli -+150cc

- apabila pada fase filling sdh reflux => low pressure

- apabila blm ada, pasien diminta mengedan untuk kencing => bila ada reflux high pressure

Pemeriksaan Lain

Renogram = melihat fungsi ginjal

Statis = DMSA

anatomi (ektopik ren), struktur dan posisi

Dinamis = MAG 3, DTPA

renal scaring, split renal function (fungsi ginjal kanan kiri) 50%. Dianggap normal bila diatas 40%.
Selain itu dilihat T1/2 normalnya dalam waktu 15 menit (kemampuan ginjal buang obat)