includes: lower urinary tract structures and functions, cystometry, terminology, male LUTS, acute urinary retention, incontinence in men and women, risk factors, treatment, surgeries, injections
1
Week 6, Lecture
Incontinence and urinary retention
The lower urinary tract
Bladder and urethra
o Store urine
1ml of urine made per year of age per hour
Bladder capacity – female 350-400ml, male 400-450ml
o Empty efficiently
Structure and function
Urinary bladder
Collection and low-pressure storage
Appropriate time and appropriate place expulsion
Histology
o Connective tissue layer
o Smooth muscle coat
o Transitional cell epithelium – elastic barrier impervious to urine
We always make urine
Bladder expands
Urine forms
When the bladder muscles sense the bladder is full the brain senses convenience
Bladder stretches depending on convenience
Pressure increases
Difference between male and female
Male have prostate
o Men with enlarge prostates have problems
Normal micturition
Normal voiding occurs smoothly
Different in those with no connection – paralysed
o Ass involuntarily as cannot control
Cystometry
Pressure volume relationship
Measures pressure
Tube goes in the bladder
Pressure measured inside bladder and inside rectum
Liquid pumped into bladder
How long does it take to pass urine?
Less than a minute
Around 30 second
Anyone who takes longer tends to have other issues
Terminology
LUTS – lower urinary tract symptoms
BPH – benign prostatic hyperplasia – a histology diagnosis
BPE – benign prostatic enlargement
BOO – bladder outflow obstruction
Storage and irritative symptoms
Link between prostate and bladder known for a long time
Male LUTS
, 2
Week 6, Lecture
Voiding
o Weak flow
o Hesitancy
o Dribbling
o Incomplete emptying
Storage
o Urgency
o Frequency
o Nocturia
Post micturition
o Dribbling
Lower tract symptoms are common
Voiding difficulty
Less common in women
Common in men
o Prostate interference
Effects of obstruction
Symptoms
Other consequences
o UTIs
o Stones
o Renal failure
Acute urinary retention
Inability to pass urine
Tends to be painful
Depends on how much volume
If there is a large volume, then the muscles have been stretched
Muscles weaken on a long-term basis
Irreversible
Management
Phytotherapy
Alpha-blockers
5ARIs
Surgery
o Minimally invasive surgery
o Loop
o Makes a bigger channel
Detrusor Failure
Whenever obstruction is removed still unable to relieve
Unable to fully empty bladder
May need a catheter
Incontinence
Involuntary loss of urine
Weakness
Stress or urge incontinence
Stress – patients leak when they strain
Urge – abnormal contractions
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