Voiding dysfunction Flashcards
conditions associated with OAB
Lack of estrogen (menopause)
obesity
pelvic organ prolapse
pelvic floor dysfunction
overflow incontinence
underactive detrusor with chronic retention and bladder overdistention
anatomic urethral obstructions
functional urethral obstructions
anatomic - prostatic enlargement
urethral stricture
poor incontinence surgery
functional (hyperactive sphincter)
neurogenic - detrusor sphincter dyssynergia
non-neurogenic - dysfunctional voiding
urinary incontinence due to sphincter =
stress urinary incontinence
guarding reflex
micturirtion reflex can be abolished by external sphincter contraction
OAB = ___ and leads to ____
OAB = detrusror overactivity leading to urge incontinence
causes of urinary retention due to detrusor
Neurogenic
myogenic
psychogenic
Rx - anticholinergics, a-agonists, narcotics
innvervation type
detrusor contractipon
internal sphincter relazation
detrusor contraction - parasympathetic
internal relaxation - sympathetic
CNS role
volluntary control
inhibition of reflex detrusor contraction
coordinates voiding - detrusor contraction, internal, external sphincter relaxation
pontine mucturition center
urinary incontinence due to detrusor =
overactive bladder / urge urinary incontinence
incontinence due to weakness of sphincter and supporting structures of neck and bladder
Stress urinary incontinence
causes / risk factors for Stress urinary incontinence
vaginal / pelvic trauma (births, surgery, trauma, vaginal prolapse)
lack of estrogen (menopause)
neurologic
radiation therapy > scarring
obesity
presentation OAB
spasms
urinary frequency + urgency
nocturia
incontinence - don’t reach toliet in time
management of retention
cathetar drainage (indwelling or intermittent
treat UTI
discontinue meds (anticholinergics)
relieve obstruction (alpha blockers to reduce sphincter tone, prostate surgery)
neuromodulation (for non-obstructive retention)
treatment stress incontinence
Kegels
weight loss
Duloexitine - 5HT+NE reuptake inhibitor > increase output to external sphincter
pathophys of post-op retention
anesthetics (antichlinergics) inhibit detrusor
increased sympathetic tone / bladder neck contraction
OAB treatment
Behavior - fluid management, kegels
Rx - antichilinergics (oxybutynin, tolterodine)
b-3 andrenergic agonist (myrbetriq)
sympathetic role
facilitates urine storage
inhibition of detrusor (directic via B3 adrenergic)
(indirect via inhibition of parasymptathetic
contraction of internal sphincter / bladder neck (a adrenergic receptors)
parasymptathetic role
facilitates micturition
direct motor action of detrusor contraction (ach, muscarinic receptors)
indirect facilitation of detrusor contraction via stretch receptors
cause of OAB
UTI / inflammation
Neurologic - spinal cord injury, stroke MS
Metabolic (diabetes)
Urethral obstruction
