incontinence and urinary retention lecture notes

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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

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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