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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
Two functional sphincter mechanisms:Proximal bladder neck (internal urethral sphincter)Distal urethral sphincter (DUS) (external urethral sphincter)
Reproductive system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The male urethra forms a common pathway for the flow of urine and the flow of semen from the male reproductive organs and is approximately 20 cm long. It extends from the internal urethral sphincter of the urinary bladder to the extremity of the penis. It passes through the prostate gland and then turns at an angle of 90° through the perineum and then passes downwards, surrounded by the structures of the body of the penis.
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Incontinence is considered one of the ‘geriatric giants’. Stress incontinence is a common problem in older women, and it often causes the patient significant distress and embarrassment. Weakness of the pelvic floor is responsible for stress incontinence, and is commonly caused by the weight of the uterus during pregnancy and stretching of the muscles during pregnancy. Increasing the tone of pelvic floor muscles should be encouraged, and numerous programmes explaining how to do this, how often and for how long are advised by physiotherapists. Conservative management also includes addressing exacerbating factors, such as obesity, smoking and drinking large volumes of caffeine. Duloxetine is given to some patients. The internal urethral sphincter is under autononomic control, and increasing the NA at the synapse increases sympathetic activity and increases its tone. Surgical options include referral to a urogynaecologist for consideration of tension-free vaginal tapes/sling procedures.
Dexmedetomidine versus fentanyl effect as adjuvants to bupivacaine on post spinal urinary retention in knee joint arthroscopic surgeries
Published in Egyptian Journal of Anaesthesia, 2023
Ghada M. El-Saeid, Mohsen A. Bassiouny, Toqa H. Al Sharabasy, Tamer N. Abdelrahman
In the present study, the incidence of POUR at the 3rd post-operative hour was clinically significant less in patients of the BD group, than in patients of the BF group. This is explained by Jellish et al [31], who stated that intrathecal fentanyl is potent, short acting on the μ and δ receptors in the spinal cord, it increases the incidence of POUR by; decreasing the afferent inputs from the UB, thus decreasing the urge sensation to void and the detrusor contraction, with increasing the UB capacity. Also, it decreases the parasympathetic efferent in the sacral region [18], and alters the urethral sphincter function, thus impairs the coordination between the detrusor contraction and the internal urethral sphincter relaxation, this dysfunction is dose related [32]. Also, the rostral spread to the pontine micturition center was hypothesized by Kuipers et al [33]. Baldini et al [8] stated that the synergistic block of the Aδ and C fibers by dexmedetomidine and bupivacaine, impairs the sympathetic system thus leaves the cholinergic system uninhibited, and Jarineshin et al [32] found that dexmedetomidine as an adjuvant to bupivacaine, induces analgesia without urinary retention.
Managing autonomic dysfunction in Parkinson’s disease: a review of emerging drugs
Published in Expert Opinion on Emerging Drugs, 2020
Dinkar Kulshreshtha, Jacky Ganguly, Mandar Jog
The primary function of urinary bladder is the storage and voiding of urine. This is facilitated by a synchronization between detrusor muscle and urethral sphincter, which in turn is related to the neuronal networks in the spinal cord and brain. The detrusor muscle and the internal urethral sphincter are supplied by the sympathetic and parasympathetic nervous system and are under involuntary control while the external urethral sphincter is under voluntary control and supplied by the pudendal nerve. While sympathetic stimulation causes detrusor relaxation and urethral sphincter contraction and aids storage, parasympathetic stimulation has the opposite effect and causes voiding [13]. Fifty-five to eighty percent of PD patients complain of bladder dysfunction at some point in time. Both storage (urinary urgency, frequency, nocturia, with or without incontinence) and voiding (slow and/or interrupted stream, terminal dribble, hesitancy and straining) symptoms occur in PD [14]. Nocturia, a common symptom in PD may be due to nocturnal polyuria, characterized by increased nocturnal urine production of more than 20–33% of the entire 24-h volume [15]. Reduced bladder capacity, poor compliance and detrusor overactivity (DO) have been shown in urodynamic studies [16]. The proposed mechanism for overactive bladder (OAB) symptoms in PD is disruption of the dopamine D1-GABAergic direct pathway and its GABAergic collateral to the micturition circuit, resulting in loss of inhibition of the micturition reflex and OAB symptoms [17–19].
Diurnal enuresis developing in association with risperidone and aripiprazole use in a child with autism spectrum disorder: a case report
Published in Psychiatry and Clinical Psychopharmacology, 2018
Hamza Ayaydın, Şermin Bilgen Ulgar
Risperidone acts as an antagonist on the 5HT2A and D2 receptors, also it has a strong blockade effect for α-1 and α-2 adrenergic receptors. Adrenergic blockade effect is suggested to urinary incontinence by decreasing the tonus of internal urethral sphincter [10]. One study showed an association between 5HTR2A gene polymorphisms and polysymptomatic nocturnal enuresis [13]. The antagonist activity of aripiprazole at alfa 1 and 5HT2A receptors on internal bladder sphincter and detrusor muscle, respectively, might have caused to enuresis in this case. In addition, possible reduced dopamine transmission due to partial agonist activity of aripiprazole at D2 receptors might also cause enuresis in our case. The sedative effects of antipsychotics may lead to inability to wake up during sleep and might cause nocturnal enuresis. Because our case experienced enuresis only during the day time, and her parents reported no difficulty of the patients in waking up during risperidone or aripiprazole treatment, enuresis does not seem to be related to sedation. In contrast to one case report describing nocturnal enuresis developing in association with aripiprazole [14] and another adolescent case report of diurnal enuresis developing [8], the therapeutic effect of aripiprazole has been shown in clozapine-related enuresis [5]. Early identification of this side effect combined with early prevention may increase medication adherence. In this case, aripiprazole first caused dose-dependent enuresis in a preadolescent child, which then resolved with a mild reduction in dosage. From that perspective, this case report shows, in the light of the current literature, that two different antipsychotics are able to cause diurnal enuresis and that aripiprazole can be used in the aetiology and treatment of enuresis in a dose-dependent manner. Her Naranjo adverse drug reaction probability scale score was 8 for each drug [15].