² Definitions:

1. Abnormal Emptying:

Hesitancy: trouble initiating voiding

Straining to void: voiding accompanied by abdominal straining

Poor stream: decreased force of flow of the urinary stream

Intermittent stream: a “stop-and-start” pattern of urination

Incomplete emptying: a persistent feeling of bladder fullness after voiding

Postmicturition dribble: urine loss occurring just after normal voiding has been completed

Acute urinary retention: sudden inability to void resulting in painful bladder overdistention

and the need for catheterization to obtain relief

2. Abnormal Sensation:

Urgency: a strong desire to void

Dysuria: burning pain with urination

Bladder pain: conscious, hurting, suprapubic pain in the bladder

Flank pain: pain between the lower rib cage and the ilial crest

Pressure: a feeling of heaviness or constant force being exerted in the bladder or lower pelvis

Loss of bladder sensation: decreased sensation in the bladder

3. Abnormal Bladder Contents:

Abnormal color, Abnormal smell, Hematuria, Pneumaturia, Stones, Foreign bodies.

　

² Voiding Difficulty:

1. Causes:

j failure of pelvic floor relaxation

k failure of the detrusor muscle to contract appropriately

ø Outflow obstruction: detrusor pressure > 50 cm H₂O in associated with urine flow rate < 15 ml/sec

(usually found in patients having undergone obstructive bladder neck surgery for stress incontinence)

ø Detrusor-sphincter dyssynergia in some patients with multiple sclerosis

2. Treatment: depending on the cause of the condition

À Drug therapy:

- Mild sedatives:

- a -blockers: reducing urethral tone (eg. prazosin, phenoxybenzamine)

- Cholinergic agonists: enhancing detrusor contractility (eg. bethanechol chloride)

Á Self-catheterization: the mainstay in the treatment of voiding difficulty

* The most important protection against urinary tract infection is frequent and complete

bladder emptying rather than avoidance of the introduction of a foreign body into the

bladder.

 Suppressive antibiotics:

* Acute infections should be treated with an appropriate antibiotic for 3 days.

* Chronic suppressive antibiotic therapy should not be used.

　

² Acute Urinary Retention:

1. Causes:

* Eg. epidural anesthetic during childbirth, painful P-repair leading to pelvic floor spasm

* A careful search should always be made to determine the cause of the retention,

particularly if any neurologic signs are present.

2. Treatment: (self)-catheterization

² Disorders of Bladder Sensation: among the most frustrating urogynecologic conditions

1. Causes of bladder pain or painful voiding:

- Bladder cancer (especially smokers or worker exposed to chemical)

- Urethral diverticulum

- Vulvar disease

- Endometriosis

- Chemical irritation from soaps

- Bubble bath

- Feminine hygiene products

- Urinary stones

- Urogenital atrophy from estrogen deprivation

- Sexually transmitted diseases

- Interstitial cystitis

2. Management: usually no definite diagnosis and only symptomatic treatment