EMQ Answers
Justin C. Konje in Complete Revision Guide for MRCOG Part 2, 2019
C Bladder outlet obstructionThe symptoms of bladder outlet obstruction may vary, but can include abdominal pain, continuous feeling of a full bladder, frequent of micturition, pain during urination (dysuria), problems initiating voiding, a feeling of incompletely emptying the bladder, urinary hesitancy, slow, uneven urine flow and in some cases inability to void. Straining to urinate and urinary tract infections may be associated to complications. (Urinary Incontinence and Pelvic Organ Prolapse in Women: Management Prolapse in Women: Management. NICE Guideline, Published: 2 April 2019)
Complications of Female Incontinence Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Voiding dysfunction is the most common complication following incontinence surgery. Although the incidence reported varies with the definition of voiding dysfunction, up to 20% of patients will have new urinary complaints postoperatively, most commonly de novo urgency. Unfortunately, obstructive and irritative symptoms do not necessarily correspond to urethral or bladder dysfunction, respectively. Behavioral management with fluid restriction, caffeine restriction, timed voiding, and double voiding is often helpful, and empiric pharmacotherapy is often utilized—with alpha blockers for retentive symptoms and antimuscarinics for irritative symptoms. Persistent voiding dysfunction is an indication for urodynamics evaluation. However, failure to demonstrate unstable bladder contractions does not rule out detrusor over-activity, and there is no standard definition of bladder outlet obstruction. While some investigators suggest a voiding pressure >20 cm water and peak urinary flowrate <15 mL/s signifies obstruction, in many instances there is no bladder contraction during urodynamics studies (154,155). Bladder outlet obstruction may therefore be difficult to diagnose. At the University of Arizona, video urodynamics has proven useful, where narrowing or cutoff of radiocontrast at the level of the sling may suggest surgical obstruction (Fig. 7).
Urinary Incontinence in Older Adults with Diabetes
Medha N. Munshi, Lewis A. Lipsitz in Geriatric Diabetes, 2007
The prevalence of DO increases with age, and it can be found in 21% of healthy, continent, community-dwelling older persons (27). The ability to postpone voiding decreases and the total bladder capacity may diminish, leading to increased frequency of normal voiding and urge UI. An age-related decrease in detrusor contractility (29) leads to lower urinary flow rates in both older men and women with a modest increase in PVR (up to 50 mL). Most older men have benign prostatic hyperplasia, with about one-half developing hypertrophy with the potential for bladder outlet obstruction and voiding symptoms. Obstruction also is associated with the development of uninhibited detrusor contractions. The diurnal pattern of fluid excretion can shift toward later in the day and into the night (30).
Gender discrepancies in bladder cancer: potential explanations
Published in Expert Review of Anticancer Therapy, 2020
Pravin Viswambaram, Dickon Hayne
Anatomic differences between men and women may account for some gender-related differences in UCB. Men have a thicker detrusor than women, which may thicken even further as men age, due to bladder outlet obstruction from benign prostatic hypertrophy. This could protect against rapid extravesical progression or metastases [2,15]. The prostate and prostatic urethra in men may act as a barrier in limiting the lymphovascular spread of UCB [68]. During embryonic development, the trigone and posterior bladder neck share a common origin with the proximal vagina [69]. This could explain more invasive UCB in women [20]. The absence of Denonvilliers’ fascia and a barrier between the anterior vagina wall and the posterior bladder may be responsible for increased localized invasion of UCB and lymphatic spread [16]. In women, lymphatic vessels travel through the lateral vagina walls, draining lymph from the bladder neck to the internal iliac lymph nodes, facilitating UCB spread to the urethra [68,70,71]. This justifies the excision of the anterior vaginal wall and entire urethra in female RC [16].
Cucurbitacin E glucoside from Citrullus colocynthis inhibits testosterone-induced benign prostatic hyperplasia in mice
Published in Drug and Chemical Toxicology, 2021
Salsabeel Z. Basha, Gamal A. Mohamed, Ashraf B. Abdel-Naim, Atif Hasan, Ahmed Abdel-Lateff
Fibrosis is excessive proliferation of fibroblasts and myofibroblast with accumulation of collagen and other extracellular matrix (ECM) components in and around inflamed, which can lead to permanent scarring and organ dysfunction (Gharaee-Kermani et al. 2013). Mechanistically, fibrosis is considered an inflammation-initiated process (Rodriguez-Nieves and Macoska 2013). Prostatic inflammation in BPH has been found to be associated with prostatic enlargement. Chronic inflammation has been connected with BPH that causes prostate fibrosis (Nandecha et al.2010). Investigations employing a mouse model indicated that prostate inflammation induces an increase in collagen content and a correlation between inflammation and fibrosis was established. Prostatic fibrosis is a crucial factor for the development of bladder outlet obstruction (Wu et al.2017). Our data indicated that Cu-E glucoside has a significant antifibrotic activity as it inhibited collagen deposition and α-SMA expression. It has been reported that both cucurbitacins E and B ameliorate hepatic fibrosis (Alghasham 2013, Sallam et al. 2018).
Long-term urodynamic findings following radical prostatectomy and salvage radiotherapy
Published in Scandinavian Journal of Urology, 2018
Maria Ervandian, Jens Christian Djurhuus, Morten Høyer, Charlotte Graugaard-Jensen, Michael Borre
The non-invasive uroflowmetry showed a prolonged flow in six patients that indicated the presence of infravescial obstruction, as a result of either bladder outlet obstruction or a poorly contractile detrusor muscle. With regard to the simultaneous measurement of bladder pressure and bladder function, 10 patients had a non-compliant bladder and detrusor overactivity, and involuntary contractions were present in seven patients. In the voiding phase, bladder outlet obstruction was present in seven patients with increased detrusor pressure and reduced flow rates; only three of the seven patients had signs of urethral stricture on their UPP. Based on the UPP, these results demonstrate a strong relationship between low MUP and daily urinary incontinence.
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