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intermittent voiding pattern neurological

Katarina Ivana Tudor, Ryuji Sakakibara, Jalesh N Panicker
The lower urinary tract (LUT) in health is regulated by coordinated multi-level neurological inputs which require an intact central and peripheral nervous system. Lower urinary tract dysfunction is, therefore, a common sequelae of neurological disease and the patterns of bladder storage and voiding dysfunction depend upon the level of neurological lesion. Evaluation includes history taking, bladder diary, urological examination when relevant, ultrasonography and urodynamic testing when indicated. Antimuscarinic agents are the first line treatment for patients with storage dysfunction...
December 2016: Journal of Neurology
Jalesh N Panicker, Clare J Fowler, Thomas M Kessler
Lower urinary tract (LUT) dysfunction is a common sequela of neurological disease, resulting in symptoms that have a pronounced effect on quality of life. The site and nature of the neurological lesion affect the pattern of dysfunction. The risk of developing upper urinary tract damage and renal failure is much lower in patients with slowly progressive non-traumatic neurological disorders than in those with spinal cord injury or spina bifida; this difference in morbidity is taken into account in the development of appropriate management algorithms...
July 2015: Lancet Neurology
Drew C Baird, Dean A Seehusen, David V Bode
Enuresis is defined as intermittent urinary incontinence during sleep in a child at least five years of age. Approximately 5% to 10% of all seven-year-olds have enuresis, and an estimated 5 to 7 million children in the United States have enuresis. The pathophysiology of primary nocturnal enuresis involves the inability to awaken from sleep in response to a full bladder, coupled with excessive nighttime urine production or a decreased functional capacity of the bladder. Initial evaluation should include a history, physical examination, and urinalysis...
October 15, 2014: American Family Physician
Miki Haifler, Kobi Stav
Dysfunctional voiding is characterized by an intermittent and/or fluctuating flow rate due to involuntary intermittent contractions of the periurethral striated or levator muscles during voiding in neurologically normal women (International Continence Society definition). Due to the variable etiology, the diagnosis and treatment of DV is problematic. Frequently, the diagnosis is done at a late stage mainly due to non-specific symptoms and lack of awareness. The objectives of treatment are to normalize micturition patterns and prevent complications such as renal failure and recurrent infections...
May 2013: Israel Medical Association Journal: IMAJ
Heidi A Stephany, Douglas W Strand, Christina B Ching, Stacy T Tanaka, Ginger L Milne, Mariana M Cajaiba, John C Thomas, John C Pope, Mark C Adams, John W Brock, Simon W Hayward, Robert J Matusik, Douglass B Clayton
PURPOSE: Bladder over distention secondary to anatomical or functional obstruction can eventually lead to pathological changes, including decreased elasticity and contractile dysfunction. We hypothesized that chronic bladder distention in a murine model would activate hypoxia dependent signaling pathways despite intermittent relief of distention. MATERIALS AND METHODS: Female C57Bl/6 mice were oophorectomized at age 5 to 6 weeks and underwent urethral catheterization and 90-minute bladder distention...
October 2013: Journal of Urology
V Zivkovic, M Lazovic, M Vlajkovic, A Slavkovic, L Dimitrijevic, I Stankovic, N Vacic
BACKGROUND: Dysfunctional voiding (DV) in neurologically normal children is characterized by involuntary intermittent contractions of either the striated muscle in external urethral sphincter, or the pelvic floor during voiding. Urinary incontinence, pelvic holding maneuvers, voiding difficulties, urinary tract infections (UTIs), constipation and vesicoureteral reflux are highly associated with DV. AIM: To investigate the role of abdominal and pelvic floor muscle (PFM) retraining in children with DV...
September 2012: European Journal of Physical and Rehabilitation Medicine
Sven Wenske, Andrew J Combs, Jason P Van Batavia, Kenneth I Glassberg
PURPOSE: Worldwide, uroflowmetry without simultaneous electromyography is often the only testing performed during the initial assessment of children with lower urinary tract symptoms. Various alterations in uroflow pattern are thought to indicate particular types of lower urinary tract conditions, specifically staccato uroflow indicating dysfunctional voiding and intermittent/fractionated uroflow indicating detrusor underactivity. We determined how reliable uroflow pattern alone is as a surrogate for simultaneously measured pelvic floor electromyography activity during voiding, and how well staccato and interrupted uroflow actually correlate with the diagnoses they are presumed to represent...
June 2012: Journal of Urology
David S Finley, Una Lee, Diana McDonough, Shlomo Raz, Jean deKernion
PURPOSE: Urinary retention is a common complication after orthotopic neobladder urinary diversion. We reviewed a case series of women who underwent neobladder creation and discuss anatomical findings, and urinary retention etiology and prevention. MATERIALS AND METHODS: We retrospectively reviewed the records of all orthotopic neobladder urinary diversions in female patients performed at our institution from 1999 through 2010. We abstracted baseline clinical and demographic characteristics, operative information, and postoperative clinical, urodynamic, imaging and secondary procedure followup...
October 2011: Journal of Urology
Satish Chandra Mishra
OBJECTIVE: To identify whether a relationship exists between information gathered from voiding patterns, neurological status and radiological findings, and the actual dysfunction seen on cystometry in children with spina bifida. PATIENTS AND METHODS: Thirty consecutive children with spina bifida underwent clinical evaluation, urinary tract imaging and cystometry. The clinical and radiological data were correlated with actual bladder dysfunction. RESULTS: Cystometry was abnormal in 87% with overactive detrusor in 77%...
June 2007: Journal of Pediatric Urology
Midori Ichino, Yasuhiko Igawa, Satoshi Seki, Osamu Ishizuka, Osamu Nishizawa
PURPOSE: We sought to determine the etiology of high pressure voiding in male infants, and to clarify the mechanisms of its improvement with maturation. MATERIALS AND METHODS: We retrospectively reviewed 106 videourodynamic studies obtained from 78 male infants with either congenital renal abnormalities or episodes of urinary tract infection, without any neurological disorders or lower urinary tract symptoms. We evaluated the relationship between age, bladder capacity and maximum voiding detrusor pressure...
December 2007: Journal of Urology
Ibrahim Otgün, Ibrahim Karnak, Mehmet Emin Senocak, Feridun Cahit Tanyel, Arbay Ozden Ciftci, Nebil Büyükpamukçu
OBJECTIVE: To investigate lower urinary tract (LUT) functions in a prospective study in boys treated for posterior urethral distraction (PUD), as posterior urethral stricture, erectile dysfunction and incontinence can occur after various treatments for this rare injury in children. PATIENTS AND METHODS: Eleven boys were treated for PUD and resultant stricture between 1980 and 2000. Their age, the cause of trauma, extent of injury, previous treatment, and continence status were evaluated, and a urodynamic study conducted...
February 2006: BJU International
Cristiano M Gomes, Marcelo Hisano, Luis R Machado, Jose A Figueiredo, Antonio M Lucon, Flavio E Trigo-Rocha
OBJECTIVE: To describe the clinical and urodynamic features of patients with chronic voiding dysfunction secondary to schistosomal myeloradiculopathy (SM), as the clinical involvement of the spinal cord is a well recognized complication of Schistosomiasis mansoni infection. PATIENTS AND METHODS: We reviewed the records and urodynamic studies of 26 consecutive patients (17 males and nine females, aged 8-58 years) with chronic neurological and urinary symptoms secondary to SM...
October 2005: BJU International
Alex Gomelsky, Gary E Lemack, Kyle J Weld, Roger R Dmochowski
PURPOSE: The nature of bladder function following ischemic injuries to the spinal cord (vSCI) is poorly understood. We describe urodynamic (UD) findings in patients with vSCI and determined the optimal management of voiding dysfunction. MATERIALS AND METHODS: From January 1997 through September 2001, 18 patients were diagnosed with vSCI. All underwent neurological and urodynamic evaluation. The etiology of vSCI was abdominal aortic aneurysm repair in 10 patients, another surgical procedure in 4 and a spontaneous spinal cord infarct in 2...
July 2003: Journal of Urology
A Groutz, J G Blaivas, C Pies, A M Sassone
Data concerning learned voiding dysfunction (Hinman syndrome; non-neurogenic, neurogenic bladder) in adults are scarce. The present study was conducted to assess the pre-valence and clinical characteristics of this dysfunction among adults referred for evaluation of lower urinary tract symptoms. Learned voiding dysfunction was suggested by a characteristic clinical history and intermittent "free" uroflow pattern and by the absence of any detectable neurological abnormality or anatomic urethral obstruction. A definitive diagnosis was made by the demonstration of typical external urethral sphincter contractions during micturition by EMG or fluoroscopy...
2001: Neurourology and Urodynamics
M L Capitanucci, M Silveri, S Nappo, G Mosiello, N Capozza, M De Gennaro
Total Sacral Agenesis (TSA) is a rare congenital anomaly of the lower vertebral column, frequently associated with bladder dysfunction. The diagnosis is often delayed until the evidence of neurological disorders addresses at neuro-radiological examination. In the last 9 years we observed 7 children, 3 males and 4 females, with TSA. The average age at diagnosis was 8 years (range: 1-15 years). Maternal diabetes was present only in one case. In 5 patients, urological ones have been the symptoms of presentation...
March 1997: La Pediatria Medica e Chirurgica: Medical and Surgical Pediatrics
T M Jørgensen, J C Djurhuus, H D Schrøder
Symptomatology and clinical manifestations of detrusor sphincter dyssynergia are described in 23 patients without neurological disease. Their cardinal symptoms were recurrent cystitis, enuresis, frequent voiding, back pain during voiding and anal discomfort. The major objective finding was vesicoureteral reflux in 11 cases with kidney scarring in 10. Bladder trabeculation was found in 13 patients, bladder hyperreflexia in 8, and significant residual urine in 16 patients. The etiology of detrusor sphincter dyssynergia in non-neurological patients is discussed...
1982: European Urology
P E Zimmern, H R Hadley, G E Leach, S Raz
During the last 5 years 13 neurologically normal women were seen with urodynamically proved urethral obstruction after a Marshall-Marchetti-Krantz operation. These obstructed patients were treated by a simple transvaginal procedure consisting of complete urethrolysis followed by a needle urethrovesical resuspension procedure. Postoperatively, 12 patients experienced complete disappearance of the presenting symptoms, return to a normal voiding pattern and decreased residuals of urine to less than 50 cc. The remaining patient, although urodynamically unobstructed, had to remain on intermittent catheterization...
September 1987: Journal of Urology
M B Chancellor, S A Kaplan, J G Blaivas
Detrusor-external sphincter dyssynergia (DESD) is characterized by involuntary contractions of the external urethral sphincter during an involuntary detrusor contraction. It is caused by neurological lesions between the brainstem (pontine micturition centre) and the sacral spinal cord (sacral micturition centre). These include traumatic spinal cord injury, multiple sclerosis, myelodysplasia and other forms of transverse myelitis. There are three main types of DESD. In Type 1 there is a concomitant increase in both detrusor pressure and sphincter EMG activity...
1990: Ciba Foundation Symposium
J S Wheeler, D J Culkin, J S Walter, R C Flanigan
The urodynamic results in 68 females with urinary retention were reviewed. There were two groups: 39 patients with neurologic causes for retention, and 29 patients in whom possible causes for retention included: psychological history (15 patients), gynecologic pathology, and urinary tract infection. Nine patients in the neurogenic group and 13 patients in the non-neurogenic group had undergone urethral dilatation with no improvement. Upper urinary tract evaluation was unremarkable. Detrusor failure was the prominent bladder pattern in both groups...
May 1990: Urology
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