Ebook Interpretation of basic and advanced urodynamics: Part 2
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Ebook Interpretation of basic and advanced urodynamics: Part 2
Bladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2s, is less easily characterized in women. The actual prevalence of obstructed voiding in women is not well known. The EPIC study, consisting of a random sampling of 19,000 adult participants from Canada and four European countries, revealed that 19.5 % of the participating women complained of ■‘void Ebook Interpretation of basic and advanced urodynamics: Part 2ing’’ lower urinary tract symptoms (i.e., intermittency, slow stream, straining, and terminal dribble) and 59% complained of storage symptoms < i.e..Ebook Interpretation of basic and advanced urodynamics: Part 2
frequency, nocturia, urgency , urge urinary incontinence, stress urinary incontinence, mixed incontinence, and unawares incontinence) [ 1 ]. CorrelatiBladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2w ith confounding nonobstructive symptoms. Arriving at a diagnosis of bladder outlet obstruction (BOO) in women requires a detailed medical history anil physical exam and a degree of clinical suspicion prior to formal testing.Urodynamic studies serve as an indispensable diagnostic tool: however, the Ebook Interpretation of basic and advanced urodynamics: Part 2ir use and interpretation of the data with respect to female BOO are not well defined. Ultimately, the urodynamic study is used to inform the symptomsEbook Interpretation of basic and advanced urodynamics: Part 2
, the clinical suspicion, and the surgical anil medical plausibility of obstruction. This chapter will present a brief overview of the literature regaBladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2sion of Urology. Albany Medical Center. 23 Hackett Blvd. Albany. NY 12208. USA ’ e-mail: ulmcrw!<ặ mail.amc.edu; cliwdct® gmail.com8.2Symptoms of Bladder Outlet Obstruction in FemalesClassically, outlet obstruction is characterized by feelings of incomplete emptying, weak stream, intermittency, and Ebook Interpretation of basic and advanced urodynamics: Part 2hesitancy. These are the result of increased resistance to outflow between the bladder neck and the urethral meatus. Patients may present with voidingEbook Interpretation of basic and advanced urodynamics: Part 2
symptoms (slow stream, splaying stream, intermittency, hesitancy, straining to void, feeling of incomplete void, or need to immediately re-void) |3|.Bladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2ptom presentation. Obstruction may remain subclinical until the patient presents with an episode of urinary retention (e.g., during the postoperative period for an unrelated surgery ), urinary tract infection. or even renal compromise.8.3DiagnosisThe work-up for BOO should include an evaluation of p Ebook Interpretation of basic and advanced urodynamics: Part 2ostvoid residual, although emptying can be normal. Pertinent history should be obtained regarding prior urological interventions. as the cause of obstEbook Interpretation of basic and advanced urodynamics: Part 2
ruction could be iatrogenic. Providers should screen for neurological disease—diagnosed or undiagnosed—as the bladder function may be impacted and indBladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2ot mutually exclusive and may both be present in the same patient.8.3.1Anatomic ObstructionAnatomic obstruction due to anti-incontinence surgery is the most common cause of BOO in women. It can impact the bladder neck or more distal (mid) urethra. Reported rates of■£' Springer International Publishi Ebook Interpretation of basic and advanced urodynamics: Part 2ng Switzerland 2017F. Firoozi (cd.). Interpretation of Baric and Advanced Urodmamics. DOI IO.IWW78-3-3l9-43247-2_86566W.D. Ulmer and EJ.B. DeobstructiEbook Interpretation of basic and advanced urodynamics: Part 2
on in autologous slings vary front I to 33% |4). with similar repotted rates of intervention (lysis, etc.). Definite obstruction rates are difficult tBladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2group experienced complications of voiding dysfunction, which can be considered a proxy but overesti mation of obstruction |5|.Anatomic obstruction in women may he caused by pelvic organ prolapse (particularly stage III or greater) involving the anterior vaginal wall [6]. Descent of the bladder can Ebook Interpretation of basic and advanced urodynamics: Part 2kink the urethra (if the urethral lateral attachments remain rela lively intact) and obstruct urinary outflow. Other less common anatomic causes incluEbook Interpretation of basic and advanced urodynamics: Part 2
de benign masses (urethral diverticula or Skene’s duct Cyst) and malignancies (urothe lial or extrinsic mass), stones, ureterocele, urethral strictureBladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2urethra 171.8.3.2Functional ObstructionFunctional obstruction can result from any impairment of relaxation of the bladder neck or external urethral sphincter. Dysfunctional voiding may result in symptomatic obstruction. Hinman-Allen syndrome is an extreme childhood example in which patients without Ebook Interpretation of basic and advanced urodynamics: Part 2neurologic abnormalities have failure of relaxation of the external sphincter during voiding, leading to high voiding pressures and overactivity of thEbook Interpretation of basic and advanced urodynamics: Part 2
e detrusor |8|. In adult women. Fowler's syndrome similarly results in failure of external sphincter relaxation. Fowler's syndrome is typically diagnoBladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2. associated abnormal EMC showing impaired external sphincter relaxation, and discomfort during cathe terization (particularly during catheter removal) |9|. Simple high-tone pelvic fltxir dysfunction including the external urethral sphincter can also present a relative obstruction to the pelvic outl Ebook Interpretation of basic and advanced urodynamics: Part 2et [10. 11]. Primary bladder neck obstruction (PNBO) is a condition in which die bladder neck fails to open during voiding. T his is hypothesized to bEbook Interpretation of basic and advanced urodynamics: Part 2
e due to persistent mesenchyme |12|. increased sympathetic tone |I3|. or functional extension of the striated sphincter to lire bladder neck [14], In Bladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2clude detrusorsphincter and bladder neck dyssynergia (multiple sclerosis and spinal cord injury). Parkinson’s disease (pseudodyssynergia), and other less common neurologic conditions, discussed in a separate chapter. Either the smooth muscle atthe bladder neck (bladder neck dyssynergia) or the skele Ebook Interpretation of basic and advanced urodynamics: Part 2tal muscle at the external sphincter (detrusor external sphincter dyssynergia) may be affected in neurologic disease. Sirls Ct al. reported in their sEbook Interpretation of basic and advanced urodynamics: Part 2
eries that approximately 25 %' of their female population with multiple sclerosis were found to have detrusor external sphincter dyssynergia [16].8.4HBladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2ed ■cations, procedures. infections, comorbidities, and injuries. The review of systems regarding back pain, numbness, par-estliesias. as well as targeted history regarding urinary tract infection, scoliosis, "bladder lift.” and other omitted details can be invaluable. The physical exam should inclu Ebook Interpretation of basic and advanced urodynamics: Part 2de a postvoid residual measurement, pelvic exam to evaluate for organ prolapse, surgical scarring, sling, urethral mass, pelvic floor muscle hypertoniEbook Interpretation of basic and advanced urodynamics: Part 2
city, evaluation of neurological sensation and reflexes, and urethral hypermobility. There may be a role for cystoscopy, for example, seeking sling obBladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2 is paramount that the evaluating provider maintains an index of suspicion for obstruction during the interview (in particular for patients with a history of genitourinary procedures).8.5Role of UrodynamicsUrodynamic testing should not be used as a screening tool. For women with suspected bladder ou Ebook Interpretation of basic and advanced urodynamics: Part 2tlet obstruction (with or without mixed voiding symptoms), uroflow and post-void residual testing will provide initial basic data. Urodynamic pressureEbook Interpretation of basic and advanced urodynamics: Part 2
flow Studies with fluoroscopic imaging provide information on bladder neck and external sphincter function, detrusor contraction. Valsalva voiding, aBladder Outlet Obstruction: Female Non-neurogenic8William D. Ulmer and Elise J.B. De8.1IntroductionBladder outlet obstruction, well-described in males Ebook Interpretation of basic and advanced urodynamics: Part 2ladder pressure and low flow system as well as more subtle findings supporting the clinical suspicion (c.g., dilation of the bladder neck to the level of a midurethral sling on fluoroscopy).The pressure flow portion of the urodynamic testing can also rule out poor detrusor function as lire cause of Ebook Interpretation of basic and advanced urodynamics: Part 2low flow. Essential to technique is providing secure privacy for the void and enough unhurried time for a true effort. Dim lighting and running waterEbook Interpretation of basic and advanced urodynamics: Part 2
can help, and the examiner should not be in view during the attempts. The examiner should leave the room if needed. A shy voider may he given a diagnoGọi ngay
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