Overactive Bladder Ebook
The downward command by the brain to empty causes relaxation and opening of the sphincter, whereas the command to wait signals the sphincter to remain closed. The pathways between the reflex center and the brain may be damaged or interrupted in MS, producing a variety of problems and or symptoms. The specific nature of the problem depends on the location of the damage. For example, if the connections between the reflex center and the brain are severely damaged, the reflex center may assume direct control of voiding and automatically stimulate the bladder to empty whenever it fills. The most common bladder problems associated with MS are increased frequency of urination, urgency, dribbling, hesitancy, and incontinence.
Bladder problems often may be managed with medications and or other approaches. To determine the most appropriate mode of treat As mentioned previously, conflict or dyssynergia often is combined with either a spastic bladder or a flaccid bladder. Initial treatment based on the 48-hour diary is aimed at either spasticity or flaccidity if the previously described techniques do not provide adequate control, it becomes apparent that the bladder wall and the sphincter are not functioning in a coordinated fashion. Occasionally, formal testing with a bladder analysis machine'' (cystometer) is needed to accurately pinpoint the source of the problem. The problem may be helped by the addition of an alpha blocker to the treatment regimen. Most alpha blockers were developed to aid in the treatment of high blood pressure, but they also help the bladder work in a more coordinated manner. Phenoxybenzamine (Dibenzyline ), clonidine, and terazosin (Hytrin ) are alpha blockers that improve coordination...
Urinary incontinence can be seen in frontal lobe seizures if the frontal cortical representation of the bladder is involved in seizure activity. This can occur without secondary generalization, but does not have a definite localizing value, because this may also be seen in temporal lobe seizures. Urinary incontinence is not a definite proof of an epileptic event, because 44 of patients with nonepileptic psychogenic seizure reported urinary incontinence with their events (43). Ictal urinary urge was also shown to localize to the nondominant hemisphere (44). Stool incontinence is exceedingly rare as a manifestation of epilepsy and could suggest other origins for the patient's episodes.
Neurologically intact patients with overactive bladders were found to have a four-fold increase in a-receptor density in the detrusor muscle when compared with those with normal bladders. This may provide a possible explanation for the clinical usefulness of a-antagonists in this patient population (51). Studies in women with LUTS have not shown definite benefit from a-blocker therapy. Further discouraging their use, the development of incontinence has been noted. A double-blind, randomized study comparing terazosin to placebo in women with significant LUTS failed to demonstrate any significant improvement in AUA symptom scores in the treatment group (52). Two patients in the treatment arm developed stress urinary incontinence necessitating cessation of the medication. In a review of women treated with prazosin, terazosin, or doxazosin for hypertension, 40.8 were found to have complaints of urinary incontinence vs 16.3 in age- and parity-matched controls. After discontinuing the...
Hemorrhagic cystitis has been reported in one-third of patients receiving daily oral CTX, and there is a significant but lower incidence of bladder fibrosis and carcinoma. These abnormalities are caused by the CTX urinary metabolite acrolein. IV CTX is associated with a significantly lower incidence of bladder problems. Appropriate hydration, nighttime voiding, and the use of 2-mercaptoethane sulfonate can help to decrease bladder toxicity. In patients on long-term CTX, either oral or IV, monthly urinalysis is needed to monitor for hematuria. The finding of hematuria should be followed by cystoscopy. Note the development of bladder cancer can occur many years after the institution of CTX. Thus, long-term surveillance is needed.
Multiple sclerosis (MS) commonly attacks people in their 20s or 30s and progresses at intervals and at varying rates. It involves patchy loss of myelin with hardening (sclerosis) of tissue in the CNS. The symptoms include vision problems, tingling or numbness in the arms and legs, urinary incontinence, tremor, and stiff gait. MS is thought to be an autoimmune disorder, but the exact cause is not known.
The miscellaneous drugs are used to relieve the symptoms associated with an overactive bladder (involuntary contractions of the detrusor or bladder muscle) that sometimes occur due to disorders such as cystitis, prostatitis, or other affected structures such as the kidney or the urethra. Overactive bladder is estimated to affect more than 16 million individuals in the United States. Symptoms of an overactive bladder include urinary urgency, frequent urination day and night, and urge incontinence, accidental loss of urine caused by a sudden and unstoppable need to urinate. These drugs also help control the discomfort associated with irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, and endoscopic procedures. Other miscellaneous drugs are used to relieve the pain associated with irritation of the lower genitourinary tract (eg, phenazopyridine) caused by infection, trauma, surgery, and endoscopic procedures.
During a follow-up visit, she presented with a significant prominence of the right scapula and back pain in the mid and lower back. She denied numbness or tingling of the lower extremities, bowel or bladder problems, chest pain, and shortness of breath. A CT scan of the upper thoracic spine showed a prominent rotatory scoliosis deformity of the right posterior thorax with acute angulation of the ribs. Her deformity is a common consequence of overcorrection of prior spinal fusion surgery, called crank shaft phenomenon.
Van Dijk et al.5 reported a series of 49 consecutive patients treated between 1986 and 2001. The mean age of the population was 63, and 80 were men. Almost all these patients (98 ) exhibited myelopathy, with 96 displaying leg weakness and or paraparesis. Ninety percent had sensory numbness or paresthesias, and 55 had pain either in the lower back or lower extremities. Eighty-two percent had urinary incontinence retention, and 65 complained of bowel dysfunction.
A disorder characterized by involuntary voiding of urine, by day and by night, which is abnormal in relation to the individual's mental age, and which is not a consequence of a lack of bladder control due to any neurological disorder, to epileptic attacks, or to any structural abnormality of the urinary tract. The enuresis may have been present from birth or it may have arisen following a period of acquired bladder control. The enuresis may or may not be associated with a more widespread emotional or behavioural disorder. Urinary incontinence of nonorganic origin
The possibility of epidural and intrathecal hemorrhage is frequently mentioned, with the obvious risk of neurological injury. This complication, unfortunately, tends to occur at the time of catheter implant. Pre-operatively, care should be taken to discontinue nonsteroidal anti-inflammatory drugs and reverse any anticoagulation. Signs of a developing hematoma are usually a sudden increase in focal back pain associated with tenderness, progressing numbness and or weakness in the lower extremities, and loss of bowel or bladder control (in the form of retention constipation or incontinence). This clinical presentation warrants immediate imaging with MRI or CT myelogram and emergent neurosurgical intervention if there is neurological deterioration.
Because TURP includes the removal of tissue at the bladder neck that encompasses smooth muscle of the internal sphincter, stress urinary incontinence can result if care is not taken to protect the external urethral sphincter complex. As described earlier, critical in avoiding injury to this sphincteric complex is the identification of the verumontanum and the resection of prostate tissue only proximal to this landmark. Stress urinary incontinence should be uncommon after TURP when the procedure is performed correctly, with an incidence well below 1 . Risk factors for postoperative stress incontinence include prostatic scarring from prior prostate surgery, radiation, and prostate cancer, all of which have the potential to obscure the verumontanum, making resection more difficult and increasing the likelihood of injury to the external sphincter. In fact, patients with a history of advanced prostate cancer who require TURP for relief of obstructive symptoms have an approx 20 risk for the...
Adult infectious disease fellowship training programs should seriously consider incorporating into their curriculum information that is relevant to the care of the elderly with infection, i.e., biology of aging (especially gerontoimmunology) geriatric pharmacology and the epidemiology, clinical manifestations, diagnostic approach, treatment, prognosis, and prevention of the most common and important infections afflicting older people. In addition, an understanding of geriatric syndromes (e.g., urinary incontinence, dementia, falls, osteoporosis) and issues of long-term care is essential for the infectious disease specialists who may care for older patients.
Adult polyglucosan body disease (APBD) is a rare autosomal recessive neurological disorder with an onset in the fifth to seventh decade of life. The clinical features consist of pyramidal tract signs, peripheral neuropathy with motor deficits, and usually pronounced distal sensory loss predominantly involving the lower limbs, hyper- or hypoactive reflexes, and urinary incontinence due to a neurogenic bladder. Most patients develop dementia, especially in the later stages of the disease. Cerebellar ataxia, extrapyramidal movement abnormalities, and seizures may occur. Some patients have predominantly signs of upper and lower motor dysfunction, prominent wasting of muscles, and fasciculations, suggesting a diagnosis of amyotrophic lateral sclerosis. The clinical course is progressive. The interval between onset of symptoms and death ranges from 3 to 21 years.
McConnell et al. observed that the median risk of stress incontinence was 1.5 after retropubic prostatectomy and about 2.6 after suprapubic prostatectomy (21). In that same analysis, total urinary incontinence occurred with a frequency of 0.5 after retropubic prostatectomy and only 0.3 using the suprapubic approach. Obviously, total incontinence can occur as a result of direct mechanical damage to the external sphincter or injury to sphincteric innervation. With respect to that latter, studies conducted by Ertekin and associates demonstrated that the somatosensory components of the pudendal nerve were not compro
Contralateral to a frontal source or spread pattern and can occur in isolation (47,48). Urinary incontinence is also common in generalized seizures, where it occurs due to the relaxation of the external sphincter (49). In absence seizures, it occurs (albeit infrequently) due to increased bladder pressure (50). Urinary incontinence is exceedingly rare in isolation, but one case is described in the text.
Adverse Effects Despite adequate and effective analgesia, many patients experience painful, annoying, and psychologically distressing neuralgias following alcohol neurolysis. The neuralgia is most commonly a dull to severe pain, which can occasionally result in a burning sensation or even a sharp, shooting pain sensation. Recovery from the pain can occur as soon as a few weeks or may take many months to resolve. The incidence of this complication is higher with a thoracic paraverte-bral sympatholytic injection than in a lumbar injection, possibly owing to the closer proximity of the somatic fibers of the sympathetic chain in the thoracic region. The dermatomal distribution of hypesthesia or anesthesia of the nerve roots treated is a rare but distressing complication. Fortunately, the recovery from this symptom is usually quick. Lumbar or sacral neurolysis can result in loss of bowel or bladder sphincter tone and thus bowel or urinary incontinence. Celiac plexus neurolysis can result...
By adding fluoroscopic imaging to the measurements of pressures and flow rates, videourodynamic testing can be used to identify the location of bladder outlet obstruction (bladder neck, prostate, external urethral sphincter, bulbar urethra). Furthermore, other abnormalities such as vesicoureteral reflux or urinary incontinence are easily demonstrated.
No urinary incontinence has been reported after TUNA, and the incidence of urethral stricture is estimated to be less than 1 (13,19,22,23,27). Bladder neck contracture has not been described. The re-operation rate for patients undergoing TUNA has been reported to be approx 10 to 15 of patients (22).
Implantation therapy for GERD has been explored for more than two decades. Early experience with injection of substances for management of vocal cord dysfunction and urinary incontinence provided evidence that injection of the proper materials was efficacious and well tolerated. Clinical observations that mild stricture formation from gastroesophageal reflux was associated with a reduction in esophageal acid exposure encouraged the use of injectable implantation materials to treat GERD. Requirements for bulking agents include chemically inert, noncarcinogenic, hypoallergenic, nonim-munogenic, capable of resisting mechanical strain, capable of being sterilized, low viscosity (capable of being injected through a small needle), nonbiodegradable, and persistence at the site of injection. Prior animal and human studies using collagen, Teflon paste, and hylan gel demonstrated that these substances failed to meet the necessary requirements for long-term
Multiple studies have demonstrated the superiority of TURP in improving symptoms associated with BPH. Data from randomized clinical trials are very convincing. When compared to watchful waiting over 3 yr, TURP resulted in more men improving (90 vs 39 ), as indicated by a reduced bother of difficulty from urinary symptoms (30). During the course of the study, 24 of men in the watchful waiting arm underwent TURP. Further follow-up of these patients for 5 yr was reported by Flanigan et al., demonstrating treatment failure rates of 10 and 21 for patients managed by TURP and watchful waiting, respectively (32). In addition, 36 of men in the watchful waiting arm eventually crossed over to invasive therapy. Treatment failure was defined as death, acute urinary retention, high residual urine volume, renal azotemia, vesical calculi, persistent urinary incontinence, or a high symptom score. The major categories of treatment failure reduced by TURP were acute urinary retention, large bladder...