Мочевой пузырь в норме 9 page

Операции по отведению мочи. Эти операции выполняют I только при прогрессирующем повреждении верхних мо-1 чевых путей, хотя и в этом случае предпочтительнее I прибегать к более простым методам отведения мочи Установлено, что денервация мочевого пузыря путем I пересечения нервных волокон вокруг его стенки, круто-1 вого рассечения стенки мочевого пузыря выше устьеш мочеточников с последующим ушиванием разреза или Я инъекций фенола или спирта в дно мочевого пузыря I имеют неблагоприятные отдаленные результаты. Слеш довательно, от этих методов лечения необходимо отка-Я заться.

Электростимуляция крестцовых корешков. Данный ме- ■ тод эффективен в некоторых случаях нейрогенной дис-Я функции мочевого пузыря гиперактивного типа. ОносЯ нован на том, что в ответ на стимуляцию симпатический] волокон передних ветвей спинномозговых нервов SI-m детрузор расслабляется. Электростимуляцию крестцо-Я вых корешков используют при травмах спинного мозгаЯ миеломенингоцеле, рассеянном склерозе. Если припробЯ] ной электростимуляции крестцовых корешков фуннвлЯ] мочевого пузыря значительно улучшается, больному им-1 плантируют электрод (как правило, в корешок S3). Задняя ризотомия. Полное пересечение (эпи- илисубдуЯ] ральное) корешков S2—S4 устраняет избыточную ак-Я тивность детрузора и приводит к увеличению функциоЯ нальной емкости мочевого пузыря. В отдельных случаях I емкость мочевого пузыря возрастает со 150—200 до Я

Глава 31. Недержание мочи

600—800 мл. При поражении спинного мозга выше кре­стцовых сегментов и нейрогенной дисфункции мочевого пузыря гиперактивного типа для улучшения сократимо­сти детрузора и опорожнения мочевого пузыря ризото-мию дополняют электростимуляцией крестцовых ко­решков.

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