Infra Pontin–Supra Sakral Spinal Nörojenik Hastalıklar
Özet
Spinal kord yaralanmaları, multiple sklerozis, servikal miyelopati, akut transvers miyelit, nöronal disrafizm, tabes dorsalis, pernisiyöz anemi, subakut kombine dejenerasyon ve poliomiyelit infra pontin–supra sakral spinal nörojenik hastalıklara yol açabilen hastalıklardır. Etkilenen medulla spinalis seviyesinin yeri ve etkilenme derecesine göre (tam ya da parsiyel tutulum) motor, duyusal ve otonom sinirler etkilenerek heterojen nöroürolojik klinik tablolar ortaya çıkmaktadır. Detrusor–sfinkter dissinerjisi, idrar kaçırma, idrar depolama ve boşaltım bozuklukları en sık görülen nöroürolojik semptom ve bulgulardır. Spinal şok; spinal kord fonksiyonlarının motor, duyusal, refleks ve otonom sinir sisteminin ani, geçici kaybı ya da bozulması ile karakterize bir klinik durumdur. Nöroürolojik klinik tablolara bağlı tekrarlayan idrar yolu enfeksiyonları, vezikoüreteral reflü, böbrek yetmezliği, ürolitiazis ve mesane kanseri riskinde artış görülebilir. Tanısal süreçte nörolojik muayene ve ürodinamik inceleme esastır. Tedavi yaklaşımları arasında temiz aralıklı kateterizasyon, antimuskarinik ilaçlar, botulinum toksin A enjeksiyonları, sfinkterotomi, nöromodülasyon ve kök hücre uygulamaları yer almaktadır. Tedavinin temel amacı, üst üriner sistemin korunması ve hastaların yaşam kalitesinin bireyselleştirilmiş medikal, cerrahi ve rehabilitatif yöntemlerle artırılmasıdır.
Referanslar
Rauschning W. (2016). New Perspectives in Spinal Anatomy. Spine, 41 Suppl 7, S4–S5.
Bican, O., Minagar, A., & Pruitt, A. (2013). The spinal cord: A review of functional neuroanatomy. Neurologic Clinics, 31(1), 1–18.
Hochman, S. (2007). Spinal cord. In The Human Nervous System (2nd ed., pp. 309–341). Elsevier.
Barbiellini Amidei C, Salmaso L, Bellio S, Saia M. Epidemiology of traumatic spinal cord injury: a large population-based study. Spinal Cord. 2022;60(9):812-9.
Kirshblum S, Snider B, Eren F, Guest J. Characterizing Natural Recovery after Traumatic Spinal Cord Injury. J Neurotrauma. 2021;38(9):1267-84.
Henke AM, Billington ZJ, Gater DR, Jr. Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review. J Pers Med. 2022;12(7).
Bacsu CD, Chan L, Tse V. Diagnosing detrusor sphincter dyssynergia in the neurological patient. BJU Int. 2012;109 Suppl 3:31-4.
Ziu E, Weisbrod LJ, Mesfin FB. Spinal Shock. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.
Lam Van Ba O, Barbe MF, Caremel R, Aharony S, Loutochin O, Jacques L, et al. Lumbar to sacral root rerouting to restore bladder function in a feline spinal cord injury model: Urodynamic and retrograde nerve tracing results from a pilot study. Neurourol Urodyn. 2018;37(1):153-62.
Trueblood CT, Singh A, Cusimano MA, Hou S. Autonomic Dysreflexia in Spinal Cord Injury: Mechanisms and Prospective Therapeutic Targets. Neuroscientist. 2024;30(5):597-611.
Won YH, Kim DS, Kim GW, Park SH, Ko MH, Seo JH. Association of bladder trabeculation and neurogenic bladder with spinal cord injury. J Int Med Res. 2022;50(6):3000605221104768.
Fitzpatrick MA, Wirth M, Nguyen J, Suda KJ, Weaver FM, Burns S, et al. Clinical outcomes associated with guideline-discordant management of asymptomatic bacteriuria and urinary tract infection in hospitalized patients with neurogenic bladder. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e195.
Hess MJ, Zhan EH, Foo DK, Yalla SV. Bladder cancer in patients with spinal cord injury. J Spinal Cord Med. 2003;26(4):335-8.
Kanematsu R, Hanakita J, Inoue T, Minami M, Suda I, Nakamura S, et al. Analysis of Neurogenic Bowel and Bladder Dysfunction Following Decompression Surgery for Cervical Spondylotic Myelopathy: A Prospective Cohort Study. Global Spine J. 2023:21925682231202381.
Gupta A, Kumar SN, Taly AB. Urodynamic profile in acute transverse myelitis patients: Its correlation with neurological outcome. J Neurosci Rural Pract. 2017;8(1):44-8.
Liu T, Ouyang L, Thibadeau J, Wiener JS, Routh JC, Castillo H, et al. Longitudinal Study of Bladder Continence in Patients with Spina Bifida in the National Spina Bifida Patient Registry. J Urol. 2018;199(3):837-43.
Bhandari J, Thada PK, Leslie SW, Ratzan RM. Tabes Dorsalis. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.
Qudsiya Z, De Jesus O. Subacute Combined Degeneration of the Spinal Cord (Archive). StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.
Referanslar
Rauschning W. (2016). New Perspectives in Spinal Anatomy. Spine, 41 Suppl 7, S4–S5.
Bican, O., Minagar, A., & Pruitt, A. (2013). The spinal cord: A review of functional neuroanatomy. Neurologic Clinics, 31(1), 1–18.
Hochman, S. (2007). Spinal cord. In The Human Nervous System (2nd ed., pp. 309–341). Elsevier.
Barbiellini Amidei C, Salmaso L, Bellio S, Saia M. Epidemiology of traumatic spinal cord injury: a large population-based study. Spinal Cord. 2022;60(9):812-9.
Kirshblum S, Snider B, Eren F, Guest J. Characterizing Natural Recovery after Traumatic Spinal Cord Injury. J Neurotrauma. 2021;38(9):1267-84.
Henke AM, Billington ZJ, Gater DR, Jr. Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review. J Pers Med. 2022;12(7).
Bacsu CD, Chan L, Tse V. Diagnosing detrusor sphincter dyssynergia in the neurological patient. BJU Int. 2012;109 Suppl 3:31-4.
Ziu E, Weisbrod LJ, Mesfin FB. Spinal Shock. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.
Lam Van Ba O, Barbe MF, Caremel R, Aharony S, Loutochin O, Jacques L, et al. Lumbar to sacral root rerouting to restore bladder function in a feline spinal cord injury model: Urodynamic and retrograde nerve tracing results from a pilot study. Neurourol Urodyn. 2018;37(1):153-62.
Trueblood CT, Singh A, Cusimano MA, Hou S. Autonomic Dysreflexia in Spinal Cord Injury: Mechanisms and Prospective Therapeutic Targets. Neuroscientist. 2024;30(5):597-611.
Won YH, Kim DS, Kim GW, Park SH, Ko MH, Seo JH. Association of bladder trabeculation and neurogenic bladder with spinal cord injury. J Int Med Res. 2022;50(6):3000605221104768.
Fitzpatrick MA, Wirth M, Nguyen J, Suda KJ, Weaver FM, Burns S, et al. Clinical outcomes associated with guideline-discordant management of asymptomatic bacteriuria and urinary tract infection in hospitalized patients with neurogenic bladder. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e195.
Hess MJ, Zhan EH, Foo DK, Yalla SV. Bladder cancer in patients with spinal cord injury. J Spinal Cord Med. 2003;26(4):335-8.
Kanematsu R, Hanakita J, Inoue T, Minami M, Suda I, Nakamura S, et al. Analysis of Neurogenic Bowel and Bladder Dysfunction Following Decompression Surgery for Cervical Spondylotic Myelopathy: A Prospective Cohort Study. Global Spine J. 2023:21925682231202381.
Gupta A, Kumar SN, Taly AB. Urodynamic profile in acute transverse myelitis patients: Its correlation with neurological outcome. J Neurosci Rural Pract. 2017;8(1):44-8.
Liu T, Ouyang L, Thibadeau J, Wiener JS, Routh JC, Castillo H, et al. Longitudinal Study of Bladder Continence in Patients with Spina Bifida in the National Spina Bifida Patient Registry. J Urol. 2018;199(3):837-43.
Bhandari J, Thada PK, Leslie SW, Ratzan RM. Tabes Dorsalis. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.
Qudsiya Z, De Jesus O. Subacute Combined Degeneration of the Spinal Cord (Archive). StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.
