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Urinary tract disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Uroflowmetry is the measurement of the rate and volume of urine passed during micturition. This is achieved by passing urine into a specialised measurement device. It may be performed following cystometry with the bladder and rectal pressure transducers still in place. In this way, the bladder pressure generated can be matched with urine flow. An underactive bladder or a high pressure required to overcome outflow tract obstruction may be observed (seeFigure 11.6).
Systemic Illnesses (Diabetes Mellitus, Sarcoidosis, Alcoholism, and Porphyrias)
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
The urodynamic findings associated with classic diabetic cystopathy include impaired bladder sensation, increased bladder capacity, decreased bladder contractility, impaired urinary flow, and, later, increased residual urine volume. The constellation of findings is often reported as a hyposensitive, underactive bladder. It is important to distinguish between outlet obstruction and decreased bladder contractility, especially in the case of impaired urinary flow. Pressure-flow urodynamics will distinguish between the two etiologies. It is uncommon to see sphincter dyssynergia in diabetic cystopathy, and one must be careful to identify abdominal straining on urodynamics (Figure 8.2) that can be associated with an interference electromyographic pattern (pseudodyssynergia).12
Systemic illnesses (diabetes mellitus, sarcoidosis, alcoholism, and porphyrias)
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Stephanie Kielb, Laurie Bachrach, Nancy Rios
The urodynamic findings associated with the classic cystopathy mentioned earlier include impaired bladder sensation, increased bladder capacity, decreased bladder contractility, impaired urinary flow, and, later, increased residual urine volume. The constellation of findings is often reported as a hyposensitive underactive bladder. It is important to distinguish between outlet obstruction and decreased bladder contractility, especially, in the case of impaired urinary flow. A pressure/flow urodynamic study will distinguish the two. It is uncommon to see sphincter dyssynergia in diabetic cystopathy, and one must be careful to identify abdominal straining on urodynamics (Figure 13.2) that can be associated with an interference EMG pattern (pseudodyssynergia).29
Neuro-urological sequelae of lumbar spinal stenosis
Published in International Journal of Neuroscience, 2018
Jason Gandhi, Janki Shah, Gargi Joshi, Sohrab Vatsia, Andrew DiMatteo, Gunjan Joshi, Noel L. Smith, Sardar Ali Khan
About 50% of the patients who seek treatment for intractable leg pain or NC due to LSS also report LUTS symptoms including incomplete bladder emptying, urinary hesitancy, incontinence, nocturia or urinary tract infections [14]. However, these symptoms can be overlooked or may be attributed to conditions such as benign prostatic hyperplasia [15]. Nevertheless, it is crucial to note that acute central LSS, usually due to a prolapsed disc, may present concomitantly with a neurological emergency known as cauda equina syndrome, which is very commonly associated with sphincter dysfunction, painless incontinence, impaired anal tone, saddle anaesthesia and bilateral sciatica [16]. Bladder dysfunction, such as neurogenic underactive bladder, has frequently been found in patients with LSS and lumbar disc herniation [17]. The pathophysiology of bladder function and micturition is complicated, especially in patients who have various disorders of the lumbar spine. Aside from LSS, urinary incontinence can also occur due to lumbar disc herniation. Neuropathic bladder can result from conditions such as LSS, tethered cord syndrome, disc herniation, trauma, lumbar spondylosis and intraspinal tumours [15]. Sekido et al. developed a rat model of LSS with the insertion of a silicone rubber in the L5–6 epidural space. These rats demonstrated symptoms of underactive bladder or detrusor underactivity, decreased voiding efficiency and increased post-void residual volume (PVR) [18–21]. Bowel and bladder symptoms are indicators of severe LSS with cauda equina compression or lesion – warranting surgical management [22].
Impact of long-term epidural electrical stimulation enabled task-specific training on secondary conditions of chronic paraplegia in two humans
Published in The Journal of Spinal Cord Medicine, 2021
Lisa Beck, Daniel Veith, Margaux Linde, Megan Gill, Jonathan Calvert, Peter Grahn, Kristin Garlanger, Douglas Husmann, Igor Lavrov, Dimitry Sayenko, Jeffrey Strommen, Kendall Lee, Kristin Zhao
Throughout the study, both participants’ neurogenic bladder was managed by self-intermittent catheterization 4–6 times per day, with P2 taking anticholinergic medications as well. A summary of UDS recordings suggest conflicting changes between participants (Table 1). Prior to EES, P1 was noted to have an underactive bladder with excellent compliance, and did not require any pharmacologic intervention. Although there was not a detectable change in voiding habits at the completion of the study, his UDS revealed a substantial alteration from a compliant, underactive bladder to an overactive, poorly compliant bladder with sustained detrusor pressure during the filling phase that reached a peak of 75 cmH2O (Table 1). Upon enrollment, P2 had a history of overactive bladder with associated detrusor sphincter dysynergy, however well controlled with anticholinergics medication. He maintained on anticholinergics throughout the study, and during end of study cystometry testing. P2 had minimal change in compliance and maximum detrusor pressures at the completion of the study. Finally, The NBSS sub-scores show conflicting results, especially related to urinary incontinence as the study progressed, with P1 noting increase episodes of incontinence, and P2 with reduced occurrence of incontinence and consequences such as urinary tract infection (UTI). P2 developed an additional symptomatic UTI at the 6-month time point of MMR sessions, and was treated with antibiotics. Both participants were symptomatic of UTI within two weeks after EES surgical implant; P2 did receive antibiotic treatment. No further symptomatic UTIs were identified while receiving EES treatment for either participant.
Pharmacological treatments available for the management of underactive bladder in neurological conditions
Published in Expert Review of Clinical Pharmacology, 2018
Seyedeh-Sanam Ladi-Seyedian, Behnam Nabavizadeh, Lida Sharifi-Rad, Abdol-Mohammad Kajbafzadeh
The clinical term of underactive bladder (UAB) is generally used to describe the symptomatic complex and signs ensuing DUA. UAB is usually accompanied by hesitancy, diminished sensation of bladder filling, a slow urinary stream, and increased post-void residue (PVR) [3,4]. It is mandatory to perform invasive pressure flow studies in order to detect reduced strength and/or duration of bladder contraction and also to differentiate with LUTS secondary to BOO [3]. Accordingly, the proper diagnosis and management of UAB remains challenging yet [5] and diversity of definitions and recommendations results in more debates.