Tratamiento del dolor o ardor al orinar (disuria)
Los trastornos miccionales funcionales son más usuales en niñas (relación 9/1 con respecto a los pequeños) y en la etapa anterior a la escuela y escolar (4-7 años de edad)11. Cuando originan afecciones (por servirnos de un ejemplo, pérdidas de orina o cambios en el patrón miccional, como urgencia o aumento de la frecuencia urinaria), son un motivo esencial de preocupación y de estrés para la vida popular y familiar del paciente. Se distinguen distintas entidades dentro de este conjunto de trastornos (tabla II). La vejiga hiperactiva (en ocasiones asimismo llamada vejiga no inhibida o inestable) es el cuadro más recurrente, tanto clínicamente como en las series de estudios urodinámicos21. Le siguen en continuidad la micción disfuncional y la vejiga hipoactiva o perezosa. En los niños que controlan sus esfínteres, hay una relación angosta entre infecciones del tracto urinario (ITU), electronicstracker.Com reflujo vesicoureteral (RVU), estreñimiento y trastornos miccionales. Varios autores usan la denominación de síndrome de eliminación disfuncional para resaltar la frecuente asociación entre el estreñimiento y los trastornos miccionales5.
A veces, las anomalías de la médula espinal no son evidentes (espina bífida esconde) y únicamente se expresan por incontinencia urinaria y/o fecal. La espina bífida esconde es el defecto de los cuerpos vertebrales lumbosacros en la línea media (por norma general, en el nivel L5-S1), sin protusión de la medula espinal ni las meninges. La mayoría de los individuos no presenta signos neurológicos y la malformación no posee ninguna consecuencia. Esta habitualmente no piensa patología de la médula espinal pero, de modo inusual, se asocia a patologías como la siringomielia, la diastematomielia y la médula anclada. Su detección precoz puede evitar el daño neurológico y las consecuencias de la vejiga neurógena. Si sospechamos patología medular (tabla IV), la resonancia imantada es el método diagnóstico de elección para detectar la patología espinal31.
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Closet Snake
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