CHAPTER 26
DISTURBANCES OF THE BLADDER AND
UPPER URINARY TRACT
Terminology and definition
The term 'neurogenic bladder' (McLellan, 1939) is used generally as a collective noun
primarily for dysfunctions of the urinary bladder resulting from lesions of the peripheral
or central parts of the nervous system. Moreover, in recent years the term 'neurogenic
bladder' has often been specifically associated with injuries of the spinal cord or cauda
equina. Yet, this term is really a misnomer, as the function of the normal bladder is in
itself neurogenic. The neurogenic dysfunctions of the bladder may be due to brain lesions
(cortex, hypothalamus, midbrain, pons or oblongata), or affliction of the spinal cord at,
above or below the spinal micturition centre in the lumbosacral cord. Furthermore, they
may result from lesions of the sympathetic innervation or from spinal roots and their
peripheral ramification or from abnormalities of the autonomous intramural innervation
of the bladder wall. Therefore, in future, more accurate definition for neurological
disorders of the bladder will be necessary, such as cneurogenic vesical or bladder dysfunc
tion' due to cortical, or subcortical or spinal cord etc., lesions, which will facilitate
generally acceptable nomenclature.
Any consideration of vesical disorders resulting from affliction of the nervous system
must always include recognition and evaluation of the anatomical structures and their
abnormalities—either congenital or acquired—which have existed previous to the
neurological lesions, as they may greatly influence the abnormal function resulting from
the neurological deficit. In this connection, special attention must be paid to the pre
existing habits of micturition.
Some anatomical aspects
Certain relevant anatomical data are reviewed here which are fundamental for the
understanding of the physiology and pathophysiology of the bladder and ureter in their
relationship to renal function and pathology. In particular, the close anatomical connec
tions of the bladder-ureter complex explains the direct route taken by ascending infection.
The human bladder is a multi-layered, muscular, membraneous hollow organ,
varying in shape and capacity, which serves as a fluid reservoir. In the new-born, the
bladder is of ovoid shape and lies chiefly in the abdomen adjacent to the ventral abdominal
wall. From the apex of the bladder the medial umbilical ligament, a residual of the obliter
ated urachus, extends to the umbilicus, as also do the two lateral umbilical ligaments
which are residua of the obliterated umbilical arteries. The knowledge of these anatomical
connections are of importance as they may give rise later to abnormalities, as will be
seen later. In the adult, when emptied, the bladder lies totally within the pelvis and has
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