contraction of this meshwork of fibers results in simultaneous reduction of the bladder in all its diameters.
The normal adult female urethra is between 3 and 5 cm in length, It is lined with pseudo-stratified transitional cell epithelium in its proximal half and distally by non-keratinized stratified sequamous epithelium .
2. Race : white women are more liable than black women.
3. pregnancy : pregnancy is responsible for marked changes in the urinary tract and consequently lower urinary symptoms are common and reflect normal physiological change due to high progesterone levels and pressure effect of gravid uterus .
Epispadias , which is due to faulty midline fusion of mesoderm, result in widened bladder neck , short urethra , separation of symphysis pubis and imperfect sphincteric control.
patient present with stress incontinence which not responding to conventional suprapubic operation to elevate the bladder neck , It may be wiser to proceed straight to urethral reconstruction or an artificial urinary sphincter.
nocturnal enuresis(bed wetting) may occur, symptoms of voiding difficulty include hesitancy, a poor stream, straining to void.
Apart from the symptoms of lower urinary tract dysfunction, it is important to take a full history from all women who present with urinary incontinence. other gynaecological symptoms such as prolapse or menstrual disturbances may be relevant.
The aim of urodynamic investigations is to provide accurate diagnosis of disorders of micturition and they involve investigation of lower urinary tract and pelvic floor dysfunction these investigation range from simple procedure to sophisticated studies only available in tertiary referal centres .
A urinary diary is a simple record of the patients fluid intake and output, episodes of urgency and leakage are recorded .
a ssugested practice is one week for follow up, these diaries recall provide an assessment of functional bladder capacity and to monitor conservative treatment e.g . bladder re-education, electrical stimulation and drug therapy .
Is a radio-opaque filling medium used during cystometry ,the urinary tract can be visualized by X- ray screening.
Videocystourethrography can provide more information to detect vesico-ureteric reflux, any detrusor contraction and leakage can be noted, also trabeculation and bladder,urethral diverticulae can be seen.
bladder wall thickness of an empty bladder can be measured transvaginally giving reproducible and sensitive method of screening for detrusor overactivity ( bladder wall thickness > 5mm give predictive value of 94% in the diagnosis of detrusor overactivity).
shortening the second stage of labour and reducing traumatic delivery may result in fewer women developing stress incontinence , there have been some role of hormon replacement therapy , and role of pelvic floor exercises before and during pregnancy .