Voiding Disorders

Abstract: SECTION A: The BASIC SCIENCES the Anatomy of the Bladder, Urethra and Pelvic Floor. Clinical Physiology of the Bladder, Urethra and Pelvic Floor. Neuropharmacology of the Lower Urinary Tract. Pharmacologic Treatment of Voiding Dysfunction. Hydrodynamics and Mechanics of the Bladder and Urethra SECTION B: The PRINCIPLES and PRACTICE of URODYNAMICS the Assessment of Patients with a View to Urodynamics. Urodynamic Equipment. The Practice of Urodynamics. The Interpretation of Conventional Urodynamics. Ambulatory Urodynamics. Urethral Pressure Profilometry, Dynamic Urethral Presures, Urethral Electrical Conductivity and Uretheral Sensitivity Measurements. Clinical Value of Electrophysiological Investigations of Patients with Urinary Symptoms. Neurophysiological Techniques for Assessment of Pelvic Floor and Striated Sphincter Muscles and Their Innervation. Computers in Urodynamics. Incontinence Clinics SECTION C: UPPER TRACT URODYNAMICS Upper Urinary Tract Urodynamics SECTION D: NON-NEUROPATHIC VESICO-URETHRAL DYSFUNCTION in ADULTS Bladder Outflow Obstruction in the Male. Postprostatectomy Incontinence. The Urge Syndrome. The Painful Bladder. Stress Incontinence. Voiding Dysfunction in Women. Urodynamics in the Elderly SECTION E: NEUROPATHIC VESICO-URETHRAL DYSFUNCTION in ADULTS Spinal Cord Injury. Pelvic Plexus Injury. Non-Traumatic Neurogenic Bladder Dysfunction SECTION F: VESICO-URETHRAL DYSFUNCTION in CHILDREN Urodynamics in Children. Non-Neuropathic Voiding Disorders in Children. Neuropathic Bladder in Childhood SECTION G: URINARY DIVERSION and ITS ALTERNATIVES Urinary Diversion. Undiversion. Cystoplasty. Artificial Urinary Sphincters. Electrical Stimulation in Vesicourethral Dysfunction. General Principles. Electrical Stimulation in Vesicourethral Dysfunction. Practical Devices. Peripheral Electrical Stimulation SECTION H: ANAL INCONTINENCE Anorectal Incontinence Index

Abstract: Objectives. Sacral nerve stimulation (SNS) (Medtronic, Inc., Minneapolis, MN) is an exciting new treatment for refractory voiding disorders including urinary incontinence, retention, and voiding dysfunction. It is known that both voiding and continence reflex mechanisms are organized in the sacral spinal cord and that pathologic conditions can alter the balance between these two opposing mechanisms. Methods. The background and surgical technique of SNS will be presented. This will be followed by a discussion of hypotheses on how SNS works. Results. The beneficial effects of SNS are most reasonably attributed to activation of somatic afferent axons in the sacral spinal roots. This evoked afferent activity in turn modulates sensory processing and micturition reflex pathways in the spinal cord. Hyperactive voiding can be suppressed by direct inhibition of bladder preganglionic neurons as well as inhibition of interneuroneal transmission in the afferent limb of the micturition reflex. On the other hand, voiding in patients with urinary retention can be facilitated by inhibition of reflex pathways to the urethral outlet (guarding reflexes). Conclusions. SNS, a nonablative, minimally invasive technique for urologists, holds great promise for a large number of patients who suffer debilitating and refractory urinary symptoms.

Abstract: Background Urinary dysfunction is common in Parkinson9s disease (PD); however, little is known about urinary dysfunction in early and untreated PD patients. Methods Fifty consecutive untreated PD patients (mean age, 66.7; mean disease duration, 23.6 months; and mean Hoehn & Yahr scale, 1.9) were recruited; those with other conditions that might have influenced urinary function were excluded. Patients were evaluated using a urinary questionnaire and urodynamic studies. Results Sixty-four per cent complained of urinary symptoms (storage, 64.0%; voiding, 28.0%). Urodynamic studies showed abnormal findings in the storage phase in 84%, with detrusor overactivity (DO) and increased bladder sensation without DO in 58.0% and 12.0% of patients, respectively. In the voiding phase, detrusor underactivity, impaired urethral relaxation such as detrusor sphincter dyssynergia, and bladder outlet obstruction were present in 50.0%, 8.0% and 16% of patients, respectively. In patients with both storage and voiding phase abnormalities, DO+detrusor underactivity was the most common finding. Few patients experienced urge incontinence and/or quality-of-life impairment owing to urinary dysfunction; none had low-compliance bladder or abnormal anal-sphincter motor unit potential. These urinary symptoms and urodynamic findings were not correlated with gender, disease severity or motor symptom type. Conclusion Urinary dysfunction, manifested primarily as storage disorders with subclinical voiding disorders and normal anal-sphincter electromyography, occurs in early and untreated PD patients. In cases with severe voiding disorder and/or abnormal anal-sphincter electromyography, other diagnoses should be considered.