Dr. Hatem Wagih Aly presents an overview of female urinary incontinence. There are several types including stress, urge, mixed, situational, and overflow incontinence. Stress incontinence can be caused by genuine stress incontinence, mixed incontinence, pelvic organ prolapse, stress induced detrusor overactivity, urethral hypermobility, intrinsic sphincter deficiency, or neurogenic causes. Urge incontinence can result from bladder overactivity, neurogenic causes, myogenic factors, inflammation/infection, bladder hypersensitivity, obstruction, pelvic organ prolapse, previous surgery, urethral abnormalities, or detrusor sph
BLADDER PHYSIOLOGY AND DISORDERS-1.pptxSuhailRafik1
This document discusses bladder physiology, disorders, and treatment. It begins with the anatomy and nerve supply of the bladder. It then explains Bradley's loops, which describe the pathways controlling bladder function from the cortex to the bladder. Different types of bladder disorders are classified, including uninhibited cortical, automatic/reflex, autonomous, sensory paralytic, and motor paralytic bladders. Stress incontinence is also discussed. Treatment aims to protect the upper urinary tract, improve continence, and restore bladder function while improving quality of life. Conservative and medical therapies as well as external appliances are described.
THE URINARY INCONTINENCE AND IT'S MANAGEMENT DETAILS WITH APPROPRIATE EXPLANATION
Introduction of urinary incontinence,
Etiology of urinary incontinence,
Risk factors associated with urinary incontinence,
Types of urinary incontinence,
Pathophysiology of Urinary incontinence,
Clinical manifestations of urinary incontinence,
Diagnostic evaluations of urinary incontinence,
Management of urinary incontinence- Behavioural techniques, Drug therapy, surgical management, medical devices and Physiotherapy assessment and management in details with appropriate explanation with the help of the SlideShare .
Telegram channel - https://t.me/bhuneshwarmishra08/4?single
Facebook page - https://m.facebook.com/Bhuneshwarmishra08/
Instagram page - https://www.instagram.com/the_perfect_physio_tutorial/?r=nametag
YouTube channel - https://youtube.com/channel/UCCIEa_xDe3B-6BLfQaJb8PQ
The document discusses the overactive bladder condition, defining it as urgency with or without urge incontinence along with frequency and nocturia in the absence of other pathological conditions. It provides information on the prevalence of overactive bladder which increases with age, discusses diagnostic tests like cystometry, and outlines treatment options including behavioral therapy, medication like oxybutynin, and minimally invasive procedures.
The document discusses physiology of defecation including:
- Defecation is controlled by neurological reflexes and sphincters and occurs episodically rather than continuously.
- Stretching of the rectum triggers defecation reflexes causing relaxation of internal anal sphincter and peristalsis to drive feces downward.
- External anal sphincter remains under voluntary control allowing defecation when desired.
Clinical approach to urinary incontinenceYasmin Saidat
This document discusses the definition, pharmacology, history taking, physical exam findings, investigations, and management of different types of urinary incontinence. It defines stress, urge, overflow, sensory, and bypass fistula incontinence. For each type, it describes the etiology, history, exam findings, investigation results, and management approaches including behavioral modifications, medications, injections, and surgeries. Key investigations discussed are urinalysis, bladder diary, urodynamic studies measuring post-void residual volume, uroflow, pressure flow studies, and cystometrogram. The goal of management is to treat any underlying causes and reduce symptoms through conservative or surgical methods depending on the incontinence type and severity.
The document discusses benign prostatic hyperplasia (BPH), its causes, symptoms, and treatments. BPH involves the gradual enlargement of the prostate gland due to hormonal imbalances in aging males. This causes compression of the urethra and urinary obstruction, which can lead to complications like urinary tract infections and renal failure if left untreated. Diagnostic tests and treatments include medications to reduce obstruction and surgical procedures like TURP.
The document discusses the anatomy and physiology of normal bladder function and neurogenic bladder. It describes how the central nervous system, including the brain and spinal cord, coordinates bladder filling and emptying. Lesions in different areas can result in overactive bladder, underactive bladder, or a combination. Evaluation tests and treatment options are outlined for various types of urinary incontinence resulting from neurologic issues. Intermittent catheterization is generally the best option for bladder decompression compared to indwelling catheters or suprapubic tubes.
This document discusses urodynamic testing procedures like uroflowmetry and cystometrogram that are used to evaluate lower urinary tract function and diagnose conditions like overactive bladder. It provides details on parameters measured and what different tests can reveal. Common urodynamic findings are defined, like detrusor overactivity and poor bladder compliance. Neurogenic causes of lower urinary tract dysfunction are outlined for different spinal cord injury levels. A step-wise approach to managing the neurogenic bladder is proposed starting with self-voiding and progressing to clean intermittent catheterization or other options if needed.
BLADDER PHYSIOLOGY AND DISORDERS-1.pptxSuhailRafik1
This document discusses bladder physiology, disorders, and treatment. It begins with the anatomy and nerve supply of the bladder. It then explains Bradley's loops, which describe the pathways controlling bladder function from the cortex to the bladder. Different types of bladder disorders are classified, including uninhibited cortical, automatic/reflex, autonomous, sensory paralytic, and motor paralytic bladders. Stress incontinence is also discussed. Treatment aims to protect the upper urinary tract, improve continence, and restore bladder function while improving quality of life. Conservative and medical therapies as well as external appliances are described.
THE URINARY INCONTINENCE AND IT'S MANAGEMENT DETAILS WITH APPROPRIATE EXPLANATION
Introduction of urinary incontinence,
Etiology of urinary incontinence,
Risk factors associated with urinary incontinence,
Types of urinary incontinence,
Pathophysiology of Urinary incontinence,
Clinical manifestations of urinary incontinence,
Diagnostic evaluations of urinary incontinence,
Management of urinary incontinence- Behavioural techniques, Drug therapy, surgical management, medical devices and Physiotherapy assessment and management in details with appropriate explanation with the help of the SlideShare .
Telegram channel - https://t.me/bhuneshwarmishra08/4?single
Facebook page - https://m.facebook.com/Bhuneshwarmishra08/
Instagram page - https://www.instagram.com/the_perfect_physio_tutorial/?r=nametag
YouTube channel - https://youtube.com/channel/UCCIEa_xDe3B-6BLfQaJb8PQ
The document discusses the overactive bladder condition, defining it as urgency with or without urge incontinence along with frequency and nocturia in the absence of other pathological conditions. It provides information on the prevalence of overactive bladder which increases with age, discusses diagnostic tests like cystometry, and outlines treatment options including behavioral therapy, medication like oxybutynin, and minimally invasive procedures.
The document discusses physiology of defecation including:
- Defecation is controlled by neurological reflexes and sphincters and occurs episodically rather than continuously.
- Stretching of the rectum triggers defecation reflexes causing relaxation of internal anal sphincter and peristalsis to drive feces downward.
- External anal sphincter remains under voluntary control allowing defecation when desired.
Clinical approach to urinary incontinenceYasmin Saidat
This document discusses the definition, pharmacology, history taking, physical exam findings, investigations, and management of different types of urinary incontinence. It defines stress, urge, overflow, sensory, and bypass fistula incontinence. For each type, it describes the etiology, history, exam findings, investigation results, and management approaches including behavioral modifications, medications, injections, and surgeries. Key investigations discussed are urinalysis, bladder diary, urodynamic studies measuring post-void residual volume, uroflow, pressure flow studies, and cystometrogram. The goal of management is to treat any underlying causes and reduce symptoms through conservative or surgical methods depending on the incontinence type and severity.
The document discusses benign prostatic hyperplasia (BPH), its causes, symptoms, and treatments. BPH involves the gradual enlargement of the prostate gland due to hormonal imbalances in aging males. This causes compression of the urethra and urinary obstruction, which can lead to complications like urinary tract infections and renal failure if left untreated. Diagnostic tests and treatments include medications to reduce obstruction and surgical procedures like TURP.
The document discusses the anatomy and physiology of normal bladder function and neurogenic bladder. It describes how the central nervous system, including the brain and spinal cord, coordinates bladder filling and emptying. Lesions in different areas can result in overactive bladder, underactive bladder, or a combination. Evaluation tests and treatment options are outlined for various types of urinary incontinence resulting from neurologic issues. Intermittent catheterization is generally the best option for bladder decompression compared to indwelling catheters or suprapubic tubes.
This document discusses urodynamic testing procedures like uroflowmetry and cystometrogram that are used to evaluate lower urinary tract function and diagnose conditions like overactive bladder. It provides details on parameters measured and what different tests can reveal. Common urodynamic findings are defined, like detrusor overactivity and poor bladder compliance. Neurogenic causes of lower urinary tract dysfunction are outlined for different spinal cord injury levels. A step-wise approach to managing the neurogenic bladder is proposed starting with self-voiding and progressing to clean intermittent catheterization or other options if needed.
1) The document discusses the nerve supply, reflexes, and evaluation and management of adult neurogenic bladder. It describes the sympathetic, parasympathetic, and somatic innervation of the bladder and how different types of lesions can result in overactive or underactive bladder.
2) Evaluation involves a neurological exam, bladder diary, lab tests, imaging like ultrasound, and urodynamic studies to characterize the type of neurogenic bladder and rule out complications.
3) Management depends on the type of neurogenic bladder and aims to protect the upper urinary tract while achieving continence and quality of life. It may involve conservative measures, medications, procedures like botulinum toxin injection, or surgeries like augmentation cyst
Urinary incontinence, or the inability to control urination, can be caused by issues with the bladder, urethra, or pelvic floor muscles. There are several types of incontinence including stress, urge, overflow, and mixed. Incontinence is evaluated through physical exams, urine tests, pad tests, and urodynamic studies. Treatment options include pelvic floor exercises, bladder training, medication, medical devices, and surgery to address the underlying causes. Nursing care focuses on strengthening muscles, managing symptoms, and preventing skin breakdown.
This document provides an overview of voiding disorders in children, including definitions, classifications, pathogenesis, evaluation, and treatment approaches. It discusses specific disorders like dysfunctional voiding, overactive bladder, and their potential long-term outcomes. Evaluation involves history, physical exam, urinalysis, ultrasound, and sometimes urodynamics. Treatment focuses on lifestyle changes, bladder retraining, physiotherapy, and medications to manage specific symptoms like urinary frequency or incontinence.
This document discusses neurogenic bladder and its management. It begins by describing the neural control of micturition and then classifies the two main types of neurogenic bladder - failure to store and failure to empty urine. Diagnostic evaluation and various treatment approaches are outlined, including lifestyle modifications, medications, injections, and surgeries. Management of complications like urinary tract infections is also addressed. The document also provides details on autonomic dysreflexia, a potentially life-threatening syndrome seen in spinal cord injury patients.
This document provides tips for using a PowerPoint presentation on neurogenic bladder. It recommends:
1. Allowing free downloading and editing of the slides.
2. Noting that half the slides are blank except for the title to facilitate active learning sessions where students provide information before each topic slide is shown.
3. Conducting active learning sessions by first showing a blank slide, asking students what they know about the topic, then showing the content slide. This should be repeated for revisions.
4. The presentation can also be used for self-study by viewing blank slides and thinking about the topic before reading the content slides.
This document discusses benign prostatic hyperplasia (BPH), a common condition in aging men that causes bladder outflow obstruction. It causes urinary symptoms and can lead to complications if left untreated. The document covers the causes, diagnosis, and treatment options for BPH including lifestyle changes, medications like alpha blockers, and surgical procedures if medications fail or complications occur. Treatment is aimed at relieving symptoms, improving urine flow, and preventing progression of kidney damage.
Neuro Urology...Fantastic presentation by Prof Drake of Southmeadmeducationdotnet
- The document discusses the initial assessment and management of neurogenic urinary incontinence. It covers taking a detailed history, performing a neurological examination, investigating with urinalysis and urodynamics, and classifying the neurological lesion. Special considerations for safety include assessing for detrusor sphincter dyssynergia, poor bladder compliance, autonomic dysreflexia, and latex allergies before managing symptoms. Urodynamics helps evaluate the bladder and sphincter function to guide appropriate treatment and ensure renal safety.
This document provides an overview of urinary incontinence. It begins by outlining the learning objectives, which are to understand normal bladder function, define different types of incontinence, understand their pathophysiology and assessments, and review management options. It then defines continence and incontinence. The main types of incontinence discussed are stress urinary incontinence, urgency urinary incontinence, and overflow incontinence. Risk factors, evaluations including history, exams, and tests are explained. Management options covered include lifestyle changes, pelvic floor exercises, medications, and surgeries like sling procedures.
The document discusses bladder function and various types of neurogenic bladder disorders. It covers:
- Normal bladder function and neural control of the bladder
- Different types of neurogenic bladder disorders that can result from brain, spinal cord, or peripheral nerve lesions
- Evaluation and treatment of different disorders, including catheterization options like indwelling, suprapubic, and intermittent catheters
Neurological control of Micturition order and disorderNeurologyKota
This document outlines a presentation on neurological control and disorders of micturition. It begins with anatomy and physiology of the urinary bladder and terminology used. It then discusses classification of neurogenic bladder using the Lapides classification. Specific diseases that can cause bladder issues are explained such as stroke, dementia, Parkinson's disease, and multiple system atrophy. Diagnosis and management are also briefly mentioned but not described in detail.
interstital cystitis bladder pain syndrome etiology and diagnosis.pptxSonuKumarPlash
1. The document discusses definitions, etiology, diagnosis, and clinical presentation of interstitial cystitis/bladder pain syndrome (IC/BPS).
2. IC/BPS is defined as unpleasant bladder sensations associated with urinary symptoms for over 6 weeks in the absence of infection or other causes.
3. The etiology is multifactorial and may involve defects in the bladder epithelium, mast cell activation, neurogenic inflammation, and genetic factors.
The document summarizes key aspects of esophageal anatomy and physiology. It describes the esophagus as a muscular tube divided into cervical, thoracic, and abdominal segments. It discusses the layers of the esophageal wall, blood supply, innervation, and functions of the upper and lower esophageal sphincters. Common esophageal disorders like GERD, diverticula, and motility disorders are also summarized.
Current Approach to Overactive Bladder, Issues & Management by Prof. Haleema ...Usman Hingoro
Current Approach to Overactive Bladder, Issues & Management by Prof. Haleema A. Hashmi, Obstetrician & Gynaecology, Liaquat National Hospital & Medical College, Karachi, Pakistan.
This document discusses the definitions, causes, evaluation, and management of urinary retention and anuria. It defines urinary retention as the inability to pass urine despite an urge to void, while anuria is the lack of urine production or passage. The causes of retention are discussed for different age groups and include conditions like urethral stricture, enlarged prostate, neurogenic bladder, bladder stones, and drugs. Evaluation involves history, examination, urinalysis, renal function tests, ultrasound, and urodynamics. Management depends on whether it is acute or chronic retention and may include catheterization, treating underlying causes, and surgery in some cases. Anuria is evaluated and managed based on whether its cause is pre-renal
Urinary incontinence, or the involuntary loss of urine, is a common problem that affects millions of people worldwide. It can be caused by issues with the pelvic floor muscles, which support the bladder and urethra. There are different types of incontinence including stress, urgency, and mixed incontinence. Treatment options include behavioral techniques like bladder training, pelvic floor exercises, medications to control bladder symptoms, and in severe cases, surgery to repair damaged pelvic floor muscles or tissues. Proper diagnosis involves taking a medical history and conducting physical exams and tests to determine the cause of incontinence.
The document discusses pyelonephritis, which is an inflammation of the renal pelvis and parenchyma caused by a bacterial infection. It can be caused by an ascending or hematogenous infection. Symptoms include flank pain, fever, vomiting and frequent urination. Diagnosis involves urine culture and sensitivity as well as imaging tests. Treatment aims to eliminate pathogenic organisms with antibiotics based on culture results and remove any contributing factors to decreased resistance. Mild cases may only require a short course of oral antibiotics while severe cases involving abscesses may require IV antibiotics or even drainage of abscesses.
The document discusses the urinary system and renal disorders. It provides information on the structure and function of the kidneys, nephrons, and other components of the urinary system. It also covers different types of renal disorders like urinary incontinence, including stress, urge, overflow, and reflex incontinence. Causes, symptoms, diagnostic tests, and management of urinary incontinence are described. Both non-surgical and surgical treatment options are mentioned.
This document discusses voiding dysfunction and benign prostatic hyperplasia (BPH). It notes that BPH is very common in men over 60, affecting over 40% with symptoms. It impacts quality of life by interfering with daily activities. The prevalence increases significantly with age. Symptoms can include both irritative (storage) symptoms like urgency and obstructive (voiding) symptoms like hesitancy. The pathophysiology involves both static anatomical enlargement of the prostate and dynamic increased smooth muscle tone. Overactive bladder (OAB) symptoms affect a substantial proportion of men with BPH and lower urinary tract symptoms.
laser in urology in different urology diseases.pptxKarimElattar4
Laser physics and types of lasers are summarized. Lasers produce intense beams of coherent, monochromatic radiation. Key lasers described include CO2, Nd:YAG, KTP, alexandrite, diode, Ho:YAG. Thermal, mechanical, photochemical and tissue welding effects of lasers are explained. Clinical applications of various lasers are discussed for BPH treatment, renal tumors, lithotripsy, bladder cancer, penile cancer and urethral strictures. Lasers are also used to ablate skin lesions and reconstructive procedures through tissue welding.
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1) The document discusses the nerve supply, reflexes, and evaluation and management of adult neurogenic bladder. It describes the sympathetic, parasympathetic, and somatic innervation of the bladder and how different types of lesions can result in overactive or underactive bladder.
2) Evaluation involves a neurological exam, bladder diary, lab tests, imaging like ultrasound, and urodynamic studies to characterize the type of neurogenic bladder and rule out complications.
3) Management depends on the type of neurogenic bladder and aims to protect the upper urinary tract while achieving continence and quality of life. It may involve conservative measures, medications, procedures like botulinum toxin injection, or surgeries like augmentation cyst
Urinary incontinence, or the inability to control urination, can be caused by issues with the bladder, urethra, or pelvic floor muscles. There are several types of incontinence including stress, urge, overflow, and mixed. Incontinence is evaluated through physical exams, urine tests, pad tests, and urodynamic studies. Treatment options include pelvic floor exercises, bladder training, medication, medical devices, and surgery to address the underlying causes. Nursing care focuses on strengthening muscles, managing symptoms, and preventing skin breakdown.
This document provides an overview of voiding disorders in children, including definitions, classifications, pathogenesis, evaluation, and treatment approaches. It discusses specific disorders like dysfunctional voiding, overactive bladder, and their potential long-term outcomes. Evaluation involves history, physical exam, urinalysis, ultrasound, and sometimes urodynamics. Treatment focuses on lifestyle changes, bladder retraining, physiotherapy, and medications to manage specific symptoms like urinary frequency or incontinence.
This document discusses neurogenic bladder and its management. It begins by describing the neural control of micturition and then classifies the two main types of neurogenic bladder - failure to store and failure to empty urine. Diagnostic evaluation and various treatment approaches are outlined, including lifestyle modifications, medications, injections, and surgeries. Management of complications like urinary tract infections is also addressed. The document also provides details on autonomic dysreflexia, a potentially life-threatening syndrome seen in spinal cord injury patients.
This document provides tips for using a PowerPoint presentation on neurogenic bladder. It recommends:
1. Allowing free downloading and editing of the slides.
2. Noting that half the slides are blank except for the title to facilitate active learning sessions where students provide information before each topic slide is shown.
3. Conducting active learning sessions by first showing a blank slide, asking students what they know about the topic, then showing the content slide. This should be repeated for revisions.
4. The presentation can also be used for self-study by viewing blank slides and thinking about the topic before reading the content slides.
This document discusses benign prostatic hyperplasia (BPH), a common condition in aging men that causes bladder outflow obstruction. It causes urinary symptoms and can lead to complications if left untreated. The document covers the causes, diagnosis, and treatment options for BPH including lifestyle changes, medications like alpha blockers, and surgical procedures if medications fail or complications occur. Treatment is aimed at relieving symptoms, improving urine flow, and preventing progression of kidney damage.
Neuro Urology...Fantastic presentation by Prof Drake of Southmeadmeducationdotnet
- The document discusses the initial assessment and management of neurogenic urinary incontinence. It covers taking a detailed history, performing a neurological examination, investigating with urinalysis and urodynamics, and classifying the neurological lesion. Special considerations for safety include assessing for detrusor sphincter dyssynergia, poor bladder compliance, autonomic dysreflexia, and latex allergies before managing symptoms. Urodynamics helps evaluate the bladder and sphincter function to guide appropriate treatment and ensure renal safety.
This document provides an overview of urinary incontinence. It begins by outlining the learning objectives, which are to understand normal bladder function, define different types of incontinence, understand their pathophysiology and assessments, and review management options. It then defines continence and incontinence. The main types of incontinence discussed are stress urinary incontinence, urgency urinary incontinence, and overflow incontinence. Risk factors, evaluations including history, exams, and tests are explained. Management options covered include lifestyle changes, pelvic floor exercises, medications, and surgeries like sling procedures.
The document discusses bladder function and various types of neurogenic bladder disorders. It covers:
- Normal bladder function and neural control of the bladder
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- Evaluation and treatment of different disorders, including catheterization options like indwelling, suprapubic, and intermittent catheters
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This document outlines a presentation on neurological control and disorders of micturition. It begins with anatomy and physiology of the urinary bladder and terminology used. It then discusses classification of neurogenic bladder using the Lapides classification. Specific diseases that can cause bladder issues are explained such as stroke, dementia, Parkinson's disease, and multiple system atrophy. Diagnosis and management are also briefly mentioned but not described in detail.
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1. The document discusses definitions, etiology, diagnosis, and clinical presentation of interstitial cystitis/bladder pain syndrome (IC/BPS).
2. IC/BPS is defined as unpleasant bladder sensations associated with urinary symptoms for over 6 weeks in the absence of infection or other causes.
3. The etiology is multifactorial and may involve defects in the bladder epithelium, mast cell activation, neurogenic inflammation, and genetic factors.
The document summarizes key aspects of esophageal anatomy and physiology. It describes the esophagus as a muscular tube divided into cervical, thoracic, and abdominal segments. It discusses the layers of the esophageal wall, blood supply, innervation, and functions of the upper and lower esophageal sphincters. Common esophageal disorders like GERD, diverticula, and motility disorders are also summarized.
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Urinary incontinence, or the involuntary loss of urine, is a common problem that affects millions of people worldwide. It can be caused by issues with the pelvic floor muscles, which support the bladder and urethra. There are different types of incontinence including stress, urgency, and mixed incontinence. Treatment options include behavioral techniques like bladder training, pelvic floor exercises, medications to control bladder symptoms, and in severe cases, surgery to repair damaged pelvic floor muscles or tissues. Proper diagnosis involves taking a medical history and conducting physical exams and tests to determine the cause of incontinence.
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Dr/ Hatem Wagih Aly
Fellow of European Board of Urology (FEBU)
Member of international continence society (UK)
Member of European association of Urology
Urologist in National Institute of Urology and Nephrology
Highlights on
Bladder overactivity
2. Introduction
The lower urinary tract functions as a group of
Interrelated structures with a joint function in adults
to bring about efficient and low pressure bladder
filling ,low pressure urine storage with perfect
continence and periodic complete, low pressure
voluntary evacuation.
5. Relevant Neurophisiology
1-Nervous systems:
Sympathatic nervous system. (T 11-L2)
Parasympathatic nervous system. (S2-S4 IMLC)
Somatic nervous system (S2-S4 Onuff neucleus)
2- Nerves : Hypogastric/Pelvic/Pudendal( all have sensory and
motor fibers)
3-Synaptic ganglia:in sympathatic and parasympathatic NS
4-Neurotransmitters : Mainly Acetyl choline and nor adrenaline
Ach is the transmitter of all pre and post ganglionic receptors except post
ganglionic sympathetic where transmitter is Noradrenaline
5-Receptors : Cholinergic ( Nicotinic / Muscarinic)
Adrenergic ( Alpha / Beta )
8. Somatic Nervous system
Onuffs Nucleus (S2-S4)
Pudendal Nerve.
No synaptic ganglia
Transmitter : Acetylcholine.
Receptor : Cholinergic ( nicotinic )
Action : Enhances continence by stimulating
contraction of striated urethral sphincter
9. Sensory pathway
All the 3 nerves responsible for LUT function are
mixed nerves containing both sensory and motor
fibers.
Strech receptors of the bladder( and nociceptors)
transmit impulses mainly via afferent fibers of pelvic
nerve.
Ascending and descending tracts of spinal cord
coordinate actions between spinal and supraspinal
micturation control centers
21. Endoscopic Evaluation
Indications:
When initial investigations suggest other pathology
(haematuria, pain, severe persistent symptoms of
overactive bladder ….)
Patients who previously undergone bladder ,prostate,
pelvic surgery
Suspicion of anatomical BOO if un identified by initial
investigations
22. Urodynamics Indication
Uroflow + PVR is a simple non invasive test used to
confirm the prescence of urine outflow obstruction and
efficiency of bladder Evacuation.
Limitations : Aeiteology of weak flow
Sensitivity/specificity
23. Urodynamics Indications
Indications of other urodynamics tests.
Failure of empiric treatment.
Combined voiding and storage dysfunction.
Significant morbidity of proposed treatment.
Inability to demonstrate incontinence clinically inspite of patient
complaint.
Following prior surgery for incontinence.
Following radical pelvic surgery/Radiation.
Known or suspected neurogenic disorder that may affect bladder
function.
Female obstructive symptoms/Retention.
Male incontinence
34. Definition
Bladder overactivity is the presence of phasic involuntary
contractions of detrusor muscle associated mainly with
urgency +/- urge incontinence +/- decreased compliance
during the filling phase of micturation.
Bladder overactivity can be diagnosed after exclusion of
other pathologies causing similar symptoms( eg infection)
39. Pad Test
1 hour pad test is more practical.
Drinking 500 ml water.
Weighing and wearing the pad
Variable activities ( walking, climbing stairs bending
,washing hands….)
Weighing pad after 1 hour.
More than 1-1.4 gm increase in pad = positive
40. Urodynamics findings in OAB
Voiding Diary : Frequency& nocturia/variable usually reduced
voided volumes/ urgency &/or urge incontinence.
1 Hour pad test : greater than 1.4 gm increase in weight.
Cystometry : Decreased capacity and compliance// increased
sensations// detrusor over activity.
Video urodynamics : Bladder trabeculations,+/- diverticulae+/-
vesico ureteric reflux.
41. Neurogenic voiding Dysfunction
Supra pontine : CVA/CP/Dementia/Brain tumors …..
Main effects : DO / No DSD.
Pontine (PMC/PSC) : Parkinsonism/ M.S.
Main effects: Any type of dysfunction(DO/DF/DSD/ISD)
Suprasacral spinal : SCI/MS
Main effects : DO/DSD/High voiding pressures.
Sacral and Subsacral:Meningiomyocele/spina bifida/DM
Main effects : complete lumbosacral DO/ISD
complete sacral/subsacral DF
incomplete sacral/ sub sacral DO/DF/ISD
42.
43.
44. NON Neurogenic voiding dysfunction
Bladder Hypersensitivity (PBS)
C/P :Long standing bladder/ urethral pain,pressure,
discomfort increasing with bladder filling associated with
frequency +/- urgency in the absence of any obvious cause.
Diagnoses : Lab.
Imaging.
Endoscopy.
Urodynamics: Increased sensations
No DO.
Increased voiding pressure
54. National Institute of Urology and Nephrology
Unit of Urodynamics & Neuromodulation
Presented By / Dr Hatem Wagih Aly
Fellow of European Board of Urology
(FEBU)
Member of international continence society
(UK)
Member of European association of Urology
Urologist in National Institute of Urology
and Nephrology
55. AIM IS HIGH
LIMIT IS THE SKY
PLANE / WORK HARD/ ALWAYS TRY
56. UNIT STRUCTURE /JOB DESCRIPTION
DIRECTOR
ASSISTANT DIRECTOR
SPECIALISTS
RESIDENTS
58. PAPER WORK AND ARCHIVING
COMPLETE VOIDING DYSFUNCTION SHEET
PATIENT INSTRUCTIONS FORM
INFORMED CONSENT FORM
APPOINTMENT SCHEDULE &WAITING LIST
FILLING AND ARCHIVING
59. PATIENT CIRCULATION ( 3 STATIONS )
STATION ONE (FRONT DESK)
EXPLANATION AND CONSENT
SHEET AND INVESTIGATIONS
STATION TWO ( BED ONE )
EXAMINATION & CATHETER FIXATION
STATION THREE ( URODYNAMIC BED)
TEST IN COMPLETE PRIVACY & MINMAL INTERRUPTION
NB: SECOND PATIENT SHOULD GIVE CONSENT, HISTORY,
EXAMINED AND CATHETERISED IN STATION 1& 2 WHILE FIRST
PATIENT IS DOING THE TEST IN STATION 3
60. REPORT WRITING AND REVISING
REPORT SHOULD BE WRITTEN UNDER
COMPLETE SUPERVISION OF ATTENDING
SPECIALIST.
DIFFICULT CASES SHOULD BE SUPERVISED AND
REVISED BY UNIT DIRECTOR OR HIS ASSISTANT
MOST IMPORTANT STEP
61. TRAINING & CME
INTERNATIONAL TRAINING PROTOCOLS
INTERNATIONAL GUIDELINES FOR URODYNAMIC TEST
PERFORMANCE
DOCTORS EVALUATION
LECTURES
63. INFECTION CONTROL
ACCORDING TO INTERNATIONAL AND HOSPITAL
POLICY FOR INFECTION CONTROL AND UNDER
SUPERVISION OF INFECTION CONTROL
COMMITE
64. CO ORDINATION AND TEAM WORK
HOSPITAL DEPARTMENTS
OTHER HOSPITALS
INTERNATIONAL RELATIONSHIPS
65. Female urinary incontinence
Diagnostic Tips
Dr/ Hatem Wagih Aly
Fellow of European Board of Urology (FEBU)
Clinical Fellow London University College Hospitals
Member of international continence society (UK)
Member of European association of Urology
Head of Neuro & Female Urology unit
National Institute of Urology and Nephrology
70. MIXED INCONTINENCE
Consider all Aeiteologies & DD of Stress & Urge types
More convinint & bothering type
Concomitant / Staged treatment
patient complaint/symptoms
patient QOL/ Expectation
Upper tract affection/Risk
Type of treatment
71. SITUATIONAL INCONTINENCE
Washing hands
Getting of bed
Opening the door( key in lock sign)
Sexual intercourse
THE ACTUAL CAUSE OF INCONTINENCE IN THESE
SITUATION CAN BE BLADDER OVERACTIVITY OR
BLADDER OUT LET INCOMPETENCE OR OTHER
INCONTINENCE AETIOLOGIES
73. NON CLASSIFIED INCONTINENCE
Do not have the classic presentation of any of the
previous types although may have the same aieteology
Bladder over activity in elderly & diabetics may cause
incontinence without any urgency sensation
Severe ISD can cause incontinence without any stress,
straining or cough
74. DIAGNOSTIC TOOLS
History
Incontinence sevirity scoring systems/QOL
Frequency volume charts
Examination ( general, pelvic, neurologic, cough test,Q tip)
Pad test
Laboratory investigations (urine, creatinine …..)
Imaging ( KUB/ US/ VCMG/ IVP/ CT/ MRI )
Special Tests ( Urodynamics / urethrocystoscopy)
75. Endoscopic Evaluation
Indications:
When initial investigations suggest other pathology
(haematuria, pain, severe persistent symptoms of
overactive bladder ….)
Patients who previously undergone bladder ,prostate,
pelvic surgery
Suspicion of anatomical BOO if un identified by initial
investigations
76. Urodynamics Indications
Indications of other urodynamics tests.
Failure of empiric treatment.
Combined voiding and storage dysfunction.
Significant morbidity of proposed treatment.
Inability to demonstrate incontinence clinically inspite of patient
complaint.
Following prior surgery for incontinence.
Following radical pelvic surgery/Radiation.
Known or suspected neurogenic disorder that may affect bladder
function.
Female obstructive symptoms/Retention.
Male incontinence
77. Urodynamics Evaluation
Urodynamics Tests.
Uroflowmetry.
Cystometry.
Pressure flow study.
Abdominal Leak point pressure.
Detrusor leak point pressure.
Urethral pressure profile.
Video urodynamics.
EMG is an adjunct to urodynamics Tests