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Non-Neurogenic Lower Urinary Tract Dysfunction
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Detrusor underactivity (DU) − urodynamic term:Contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span.
An Overview of Treatment Alternatives for Different Types of Neurogenic Bladder Dysfunction in Adults
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
The most frequent consequences of an overactive detrusor are incontinence, frequency, and recurrent urinary tract infections. Treatment of neurogenic detrusor overactivity is based on several techniques used alone or in combination.
Diagnosis of Chronic Fatigue Syndrome
Published in Jay A. Goldstein, Chronic Fatigue Syndromes, 2020
The urethral syndrome in women is also more common in CFS. The causes of this disorder are numerous and include various kinds of inflammation, from chlamydia to interstitial cystitis. “Detrusor dyssynergia” is often found. It is treated with anticholinergic antispasmodics, alpha blockers (as in prostatodynia), and calcium channel blockers. A few patients will have intractable detrusor hyperflexia with incontinence. Such patients could be considered for intravesical capsaicin.10 There may be tenderness of the muscles of the urogenital diaphragm, which would include the ischiocavernosus and the bulbocavernosus. These muscles are rarely examined, but could respond to the same sorts of trigger point elimination techniques as are used elsewhere.
Understanding and managing autonomic dysfunction in persons with multiple sclerosis
Published in Expert Review of Neurotherapeutics, 2021
Ivan Adamec, Magdalena Krbot Skorić, Mario Habek
Urinary symptoms can manifest either as storage phase dysfunction with incontinence or voiding phase dysfunction with retention and incomplete bladder emptying [52]. These symptoms are one of the most frequent in MS and occur during the course of the disease in up to 97% of pwMS [53]. Incontinence not only has a significant impact on quality of life but can also cause a substantial economic burden due to the cost of medications, incontinence products, and hospital stays [54]. Demyelinating lesions in the spinal cord that interrupt neural connections from the pontine micturition center to the parasympathetic sacral micturition center are thought to cause bladder dysfunction in pwMS [55]. These CNS lesions in turn can lead to detrusor hyperactivity, the most common urinary dysfunction in pwMS [56]. Urodynamic studies have demonstrated that detrusor hyperreflexia is the most common abnormality present, followed by detrusor sphincter dyssynergia and detrusor hyporeflexia [57]. The most common urinary symptom reported in the same study was urinary urgency followed by frequency, urge incontinence, stress incontinence, and dysuria [57].
Overactive bladder syndrome – focus onto detrusor overactivity
Published in Scandinavian Journal of Urology, 2021
Taras Ptashnyk, Martin Hatzinger, Federico L. Zeller, Ruth Kirschner-Hermanns
Epidemiological surveys show that OAB is present in approximately 16% of the general population aged 40 years and older [3]. Due to our ageing society, this syndrome will become more significant in the future, both from a medical and from a socioeconomical perspective [4]. Although OAB is an important issue in healthcare, it has become clear that OAB relates to many different clinical entities, with or without well-defined causes for the signs and symptoms that patients experience [5]. Patients presenting with symptoms of OAB have different findings upon urodynamic testing. Whereas some patients present with the typical signs of detrusor overactivity, others have stable bladder filling. Previously, these conditions were referred to as sensory urgency (stable bladder filling) or motor urgency (bladder filling with detrusor overactivity [6,7]. According to the International Continence Society (ICS) definition [2], the diagnosis of OAB does not require urodynamic confirmation of detrusor overactivity, and clinically, empirical therapy for OAB with anticholinergics is most commonly initiated without urodynamic testing. However, some neurologists and gynaecologists are concerned that a correct diagnosis will be missed in many patients and they will not receive the appropriate treatment because the bladder has been described as an unreliable witness [8].
Pelvic floor dysfunction in midlife women
Published in Climacteric, 2019
SUI, UUI, and even OAB are terms that refer to symptoms reported by patients. Although a classification of incontinence by symptoms alone is imperfect, it is easy, clinically useful, and cost-effective. Symptoms alone can help determine treatment paths and define the impact on quality of life. Urodynamic testing is performed for objective diagnosis and is often used prior to surgery. Such testing defines urodynamic stress incontinence as objective urine loss with increased intraabdominal pressure in the absence of a detrusor contraction. This objective finding would be expected in most women complaining of SUI. Urodynamics additionally objectively define the condition of detrusor overactivity, a bladder dysfunction with uninhibited detrusor muscle contractions (with or without urine loss) on bladder filling in the absence of infection or the obvious bladder pathology. Detrusor overactivity is most often associated with UUI and/or OAB symptoms.