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Detrusor Sphincter Dyssynergia: a Review of Physiology, Diagnosis, and Treatment Strategies
Review Article Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies John T. Stoffel Department of Urology, University of Michigan, Ann Arbor, MI, USA Correspondence to: John T. Stoffel, MD. Department of Urology, University of Michigan, Ann Arbor, MI, USA. Email: [email protected]. Abstract: Detrusor sphincter dyssynergia (DSD) is the urodynamic description of bladder outlet obstruction from detrusor muscle contraction with concomitant involuntary urethral sphincter activation. DSD is associated with neurologic conditions such as spinal cord injury, multiple sclerosis, and spina bifida and some of these neurogenic bladder patients with DSD may be at risk for autonomic dysreflexia, recurrent urinary tract infections, or upper tract compromise if the condition is not followed and treated appropriately. It is diagnosed most commonly during the voiding phase of urodynamic studies using EMG recordings and voiding cystourethrograms, although urethral pressure monitoring could also potentially be used. DSD can be sub-classified as either continuous or intermittent, although adoption of this terminology is not widespread. There are few validated oral pharmacologic treatment options for this condition but transurethral botulinum toxin injection have shown temporary efficacy in reducing bladder outlet obstruction. Urinary sphincterotomy has also demonstrated reproducible long term benefits in several studies, but the morbidity associated with this procedure can be high. Keywords: Detrusor sphincter dyssynergia (DSD); neurogenic bladder; urodynamics; external urinary sphincter (EUS) Submitted Nov 30, 2015. Accepted for publication Jan 05, 2016. doi: 10.3978/j.issn.2223-4683.2016.01.08 View this article at: http://dx.doi.org/10.3978/j.issn.2223-4683.2016.01.08 Introduction Physiology The human bladder has two functions—to store and During storage of urine, afferent nerves carry information empty urine. -
Urinary Incontinence: Impact on Long Term Care
Urinary Incontinence: Impact on Long Term Care Muhammad S. Choudhury, MD, FACS Professor and Chairman Department of Urology New York Medical College Director of Urology Westchester Medical Center 1 Urinary Incontinence: Overview • Definition • Scope • Anatomy and Physiology of Micturition • Types • Diagnosis • Management • Impact on Long Term Care 2 Urinary Incontinence: Definition • Involuntary leakage of urine which is personally and socially unacceptable to an individual. • It is a multifactorial syndrome caused by a combination of: • Genito urinary pathology. • Age related changes. • Comorbid conditions that impair normal micturition. • Loss of functional ability to toilet oneself. 3 Urinary Incontinence: Scope • Prevalence of Urinary incontinence increase with age. • Affects more women than men (2:1) up to age 80. • After age 80, both women and men are equally affected. • Urinary Incontinence affect 15% to 30% of the general population > 65 years. • > 50% of 1.5 million Long Term Care residents may be incontinent. • The cost to care for this group is >5 billion per year. • The total cost of care for Urinary Incontinence in the U.S. is estimated to be over $36 billion. Ehtman et al., 2012. 4 Urinary Incontinence: Impact on Quality of Life • Loss of self esteem. • Avoidance of social activity and interaction. • Decreased ability to maintain independent life style. • Increased dependence on care givers. • One of the most common reason for long term care placement. Grindley et al. Age Aging. 1998; 22: 82-89/Harris T. Aging in the eighties. NCHS # 121 1985. Noelker L. Gerontologist 1987; 27: 194-200. 5 Health related consequences of Urinary Incontinence • Increased propensity for fall/fracture. -
Urinary Incontinence
GLICKMAN UROLOGICAL & KIDNEY INSTITUTE Urinary Incontinence What is it? can lead to incontinence, as can prostate cancer surgery or Urinary incontinence is the inability to control when you radiation treatments. Sometimes the cause of incontinence pass urine. It’s a common medical problem. As many as isn’t clear. 20 million Americans suffer from loss of bladder control. The condition is more common as men get older, but it’s Where can I get help? not an inevitable part of aging. Often, embarrassment stops Talking to your doctor is the first step. You shouldn’t feel men from seeking help, even when the problem is severe ashamed; physicians regularly help patients with this prob- and affects their ability to leave the house, spend time with lem and are comfortable talking about it. Many patients family and friends or take part in everyday activities. It’s can be evaluated and treated after a simple office visit. possible to cure or significantly improve urinary inconti- Some patients may require additional diagnostic tests, nence, once its underlying cause has been identified. But which can be done in an outpatient setting and aren’t pain- it’s important to remember that incontinence is a symp- ful. Once these tests have determined the cause of your tom, not a disease. Its cause can be complex and involve incontinence, your doctor can recommend specific treat- many factors. Your doctor should do an in-depth evaluation ments, many of which do not require surgery. No matter before starting treatment. how serious the problem seems, urinary incontinence is a condition that can be significantly relieved and, in many What might be causing my incontinence? cases, cured. -
Acute Cerebellar Ataxia Associated with Intermittent ECG Pattern Similar to Wellens Syndrome and Transient Prominent QRS Anterior Forces
Acute cerebellar ataxia associated with intermittent ECG pattern similar to Wellens syndrome and transient prominent QRS anterior forces Andrés Ricardo Pérez-Riera, MD, PhD. Post-Graduates Advisor at Design of Studies and Scientific Writing Laboratory in the ABC Faculty of Medicine - ABC Foundation - Santo André – São Paulo – Brazil Raimundo Barbosa-Barros, MD. Specialist in Cardiology by the Brazilian Society of Cardiology (SBC) Specialist in Intensive Care by the Sociedade Brasileira de Terapia Intensiva Chief of the Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes. Fortaleza - Brazil Adrian Baranchuk, MD FACC FRCPC Associate Professor of Medicine and Physiology - Cardiac Electrophysiology and Pacing - Director, EP Training Program - Kingston General Hospital - FAPC 3, 76 Stuart Street K7L 2V7, Kingston ON Queen's University - Canada Male patient, 56 years old, white, uncontrolled hypertension, was admitted to our emergency department (ED) with reports of sudden dizziness, headache of abrupt onset, nausea, vomiting and weakness in the lower limbs. Physical examination drew attention to the presence of manifestations suggestive of cerebellar syndrome: impaired coordination in the trunk or arms and legs, inability to coordinate balance, gait, extremity, uncontrolled or repetitive eye movements, (nystagmus), dyssynergia, dysmetria, dysdiadochokinesia, dysarthria (cerebellar ataxia). Normal myocardial necrosis markers and normal electrolytes ECO 1: anteroseptal-apical akinesis; LVEF = 30% ECO 2 (third day): -
CMS Manual System Human Services (DHHS) Pub
Department of Health & CMS Manual System Human Services (DHHS) Pub. 100-07 State Operations Centers for Medicare & Provider Certification Medicaid Services (CMS) Transmittal 8 Date: JUNE 28, 2005 NOTE: Transmittal 7, of the State Operations Manual, Pub. 100-07 dated June 27, 2005, has been rescinded and replaced with Transmittal 8, dated June 28, 2005. The word “wound” was misspelled in the Interpretive Guidance section. All other material in this instruction remains the same. SUBJECT: Revision of Appendix PP – Section 483.25(d) – Urinary Incontinence, Tags F315 and F316 I. SUMMARY OF CHANGES: Current Guidance to Surveyors is entirely replaced by the attached revision. The two tags are being combined as one, which will become F315. Tag F316 will be deleted. The regulatory text for both tags will be combined, followed by this revised guidance. NEW/REVISED MATERIAL - EFFECTIVE DATE*: June 28, 2005 IMPLEMENTATION DATE: June 28, 2005 Disclaimer for manual changes only: The revision date and transmittal number apply to the red italicized material only. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual not updated.) (R = REVISED, N = NEW, D = DELETED) – (Only One Per Row.) R/N/D CHAPTER/SECTION/SUBSECTION/TITLE R Appendix PP/Tag F315/Guidance to Surveyors – Urinary Incontinence D Appendix PP/Tag F316/Urinary Incontinence III. FUNDING: Medicare contractors shall implement these instructions within their current operating budgets. IV. ATTACHMENTS: Business Requirements x Manual Instruction Confidential Requirements One-Time Notification Recurring Update Notification *Unless otherwise specified, the effective date is the date of service. -
Neurogenic Bowel Dysfunction in Patients with Multiple Sclerosis Open Access to Scientific and Medical Research DOI
Journal name: Degenerative Neurological and Neuromuscular Disease Article Designation: Review Year: 2018 Volume: 8 Degenerative Neurological and Neuromuscular Disease Dovepress Running head verso: Preziosi et al Running head recto: Neurogenic bowel dysfunction in patients with multiple sclerosis open access to scientific and medical research DOI: http://dx.doi.org/10.2147/DNND.S138835 Open Access Full Text Article REVIEW Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies Giuseppe Preziosi Abstract: Bowel dysfunction in patients with multiple sclerosis (MS) is highly prevalent. Ayeshah Gordon-Dixon Constipation and fecal incontinence can coexist and alternate, impacting on the patient’s quality Anton Emmanuel of life and social interactions, as well as burdening the caregivers. The cost for the health care providers is also significant, with increased number of hospital admissions, treatment-related Gastro-Intestinal Physiology Unit, University College London Hospital, costs, and hospital appointments. The origin is multifactorial, and includes alteration of neu- London, UK rological pathways, polypharmacy, behavioral elements, and ability to access the toilet. Every patient with MS should be sensitively questioned about bowel function, and red flag symptoms should prompt adequate investigations. Manipulation of life style factors and establishment of a bowel regime should be attempted in the first place, and if this fails, other measures such For personal use only. as biofeedback and transanal irrigation should be included. A stoma can improve quality of life, and is not necessarily a last-ditch option. Antegrade colonic enemas can also be an effec- tive option, whilst neuromodulation has not proved its role yet. Effective treatment of bowel dysfunction improves quality of life, reduces incidence of urinary tract infection, and reduces health care costs. -
Urinary Incontinence Embarrassing but Treatable 2015 Rev
This information provides a general overview on this topic and may not apply to Health Notes everyone. To find out if this information applies to you and to get more information on From Your Family Doctor this subject, talk to your family doctor. Urinary incontinence Embarrassing but treatable 2015 rev. What is urinary incontinence? Are there different types Urinary incontinence means that you can’t always of incontinence? control when you urinate, or pee. The amount of leakage Yes. There are five types of urinary incontinence. can be small—when you sneeze, cough, or laugh—or large, due to very strong urges to urinate that are hard to Stress incontinence is when urine leaks because of control. This can be embarrassing, but it can be treated. sudden pressure on your lower stomach muscles, such as when you cough, sneeze, laugh, rise from a Millions of adults in North America have urinary chair, lift something, or exercise. Stress incontinence incontinence. It’s most common in women over 50 years usually occurs when the pelvic muscles are weakened, of age, but it can also affect younger people, especially sometimes by childbirth, or by prostate or other pelvic women who have just given birth. surgery. Stress incontinence is common in women. Be sure to talk to your doctor if you have this problem. Urge incontinence is when the need to urinate comes on If you hide your incontinence, you risk getting rashes, too fast—before you can get to a toilet. Your body may only sores, and skin and urinary tract (bladder) infections. -
Surgical Treatment of Urinary Incontinence in Men
Committee 13 Surgical Treatment of Urinary Incontinence in Men Chairman S. HERSCHORN (Canada) Members H. BRUSCHINI (Brazil), C.COMITER (USA), P.G RISE (France), T. HANUS (Czech Republic), R. KIRSCHNER-HERMANNS (Germany) 1121 CONTENTS I. INTRODUCTION VIII. TRAUMATIC INJURIES OF THE URETHRA AND PELVIC FLOOR II. EVALUATION PRIOR TO SURGICAL THERAPY IX. CONTINUING PEDIATRIC III. INCONTINENCE AFTER RADICAL PROBLEMS INTO ADULTHOOD: THE PROSTATECTOMY FOR PROSTATE EXSTROPHY-EPISPADIAS COMPLEX CANCER X. DETRUSOR OVERACTIVITY AND IV. INCONTINENCE AFTER REDUCED BLADDER CAPACITY PROSTATECTOMY FOR BENIGN DISEASE XI. URETHROCUTANEOUS AND V. SURGERY FOR INCONTINENCE IN RECTOURETHRAL FISTULAE ELDERLY MEN VI. INCONTINENCE AFTER XII. THE ARTIFICIAL URINARY EXTERNAL BEAM RADIOTHERAPY SPHINCTER (AUS) ALONE AND IN COMBINATION WITH SURGERY FOR PROSTATE CANCER XIII. SUMMARY AND RECOMMENDATIONS VII. INCONTINENCE AFTER OTHER TREATMENT FOR PROSTATE CANCER REFERENCES 1122 Surgical Treatment of Urinary Incontinence in Men S. HERSCHORN, H. BRUSCHINI, C. COMITER, P. GRISE, T. HANUS, R. KIRSCHNER-HERMANNS high-intensity focused ultrasound, other pelvic I. INTRODUCTION operations and trauma is a particularly challenging problem because of tissue damage outside the lower Surgery for male incontinence is an important aspect urinary tract. The artificial sphincter implant is the of treatment with the changing demographics of society most widely used surgical procedure but complications and the continuing large numbers of men undergoing may be more likely than in other areas and other surgery and other treatments for prostate cancer. surgical approaches may be necessary. Unresolved problems from pediatric age and patients with Basic evaluation of the patient is similar to other areas refractory incontinence from overactive bladders may of incontinence and includes primarily a clinical demand a variety of complex reconstructive surgical approach with history, frequency-volume chart or procedures. -
Interstitial Cystitis/Painful Bladder Syndrome
What I need to know about Interstitial Cystitis/Painful Bladder Syndrome U.S. Department of Health and Human Services National Kidney and Urologic Diseases NATIONAL INSTITUTES OF HEALTH Information Clearinghouse What I need to know about Interstitial Cystitis/Painful Bladder Syndrome U.S. Department of Health and Human Services National Kidney and Urologic Diseases NATIONAL INSTITUTES OF HEALTH Information Clearinghouse Contents What is interstitial cystitis/painful bladder syndrome (IC/PBS)? ............................................... 1 What are the signs of a bladder problem? ............ 2 What causes bladder problems? ............................ 3 Who gets IC/PBS? ................................................... 4 What tests will my doctor use for diagnosis of IC/PBS? ............................................................... 5 What treatments can help IC/PBS? ....................... 7 Points to Remember ............................................. 14 Hope through Research........................................ 15 Pronunciation Guide ............................................. 16 For More Information .......................................... 17 Acknowledgments ................................................. 18 What is interstitial cystitis/painful bladder syndrome (IC/PBS)? Interstitial cystitis*/painful bladder syndrome (IC/PBS) is one of several conditions that causes bladder pain and a need to urinate frequently and urgently. Some doctors have started using the term bladder pain syndrome (BPS) to describe this condition. Your bladder is a balloon-shaped organ where your body holds urine. When you have a bladder problem, you may notice certain signs or symptoms. *See page 16 for tips on how to say the words in bold type. 1 What are the signs of a bladder problem? Signs of bladder problems include ● Urgency. The feeling that you need to go right now! Urgency is normal if you haven’t been near a bathroom for a few hours or if you have been drinking a lot of fluids. -
Frequently Asked Questions About Overactive Bladder
ABOUT OAB Frequently Asked Questions about Overactive Bladder What is Overactive Bladder (OAB)? If you live with OAB, you may also: Overactive Bladder (OAB) isn’t a disease. It’s the u Leak urine (incontinence): Sometimes people name of a group of urinary symptoms. The most with OAB also have “urgency incontinence.” common symptom of OAB is a sudden urge to This means that urine leaks when you feel urinate that you can’t control. Some people will the sudden urge to go. This isn’t the same as leak urine when they feel this urge. Having to “stress urinary incontinence” or “SUI.” People urinate many times during the day and night is with SUI leak urine while sneezing, laughing or another symptom of OAB. doing other physical activities. (You can learn more about SUI at UrologyHealth.org/SUI.) How common is OAB? u Urinate frequently: You may also need to go OAB is common. It affects millions of Americans. to the bathroom many times during the day. As many as 30 percent of men and 40 percent The number of times someone urinates varies of women in the United States live with OAB from person to person. But many experts symptoms. agree that going to the bathroom more than eight times in 24 hours is “frequent urination.” Who is at risk for OAB? u Wake up at night to urinate: Waking from As you grow older, you’re at higher risk for sleep to go to the bathroom more than once a OAB. But no matter what your age, there are night is another symptom of OAB. -
Diagnosis and Management of Urinary Incontinence in Childhood
Committee 9 Diagnosis and Management of Urinary Incontinence in Childhood Chairman S. TEKGUL (Turkey) Members R. JM NIJMAN (The Netherlands), P. H OEBEKE (Belgium), D. CANNING (USA), W.BOWER (Hong-Kong), A. VON GONTARD (Germany) 701 CONTENTS E. NEUROGENIC DETRUSOR A. INTRODUCTION SPHINCTER DYSFUNCTION B. EVALUATION IN CHILDREN F. SURGICAL MANAGEMENT WHO WET C. NOCTURNAL ENURESIS G. PSYCHOLOGICAL ASPECTS OF URINARY INCONTINENCE AND ENURESIS IN CHILDREN D. DAY AND NIGHTTIME INCONTINENCE 702 Diagnosis and Management of Urinary Incontinence in Childhood S. TEKGUL, R. JM NIJMAN, P. HOEBEKE, D. CANNING, W.BOWER, A. VON GONTARD In newborns the bladder has been traditionally described as “uninhibited”, and it has been assumed A. INTRODUCTION that micturition occurs automatically by a simple spinal cord reflex, with little or no mediation by the higher neural centres. However, studies have indicated that In this chapter the diagnostic and treatment modalities even in full-term foetuses and newborns, micturition of urinary incontinence in childhood will be discussed. is modulated by higher centres and the previous notion In order to understand the pathophysiology of the that voiding is spontaneous and mediated by a simple most frequently encountered problems in children the spinal reflex is an oversimplification [3]. Foetal normal development of bladder and sphincter control micturition seems to be a behavioural state-dependent will be discussed. event: intrauterine micturition is not randomly distributed between sleep and arousal, but occurs The underlying pathophysiology will be outlined and almost exclusively while the foetus is awake [3]. the specific investigations for children will be discussed. For general information on epidemiology and During the last trimester the intra-uterine urine urodynamic investigations the respective chapters production is much higher than in the postnatal period are to be consulted. -
Abadie's Sign Abadie's Sign Is the Absence Or Diminution of Pain Sensation When Exerting Deep Pressure on the Achilles Tendo
A.qxd 9/29/05 04:02 PM Page 1 A Abadie’s Sign Abadie’s sign is the absence or diminution of pain sensation when exerting deep pressure on the Achilles tendon by squeezing. This is a frequent finding in the tabes dorsalis variant of neurosyphilis (i.e., with dorsal column disease). Cross References Argyll Robertson pupil Abdominal Paradox - see PARADOXICAL BREATHING Abdominal Reflexes Both superficial and deep abdominal reflexes are described, of which the superficial (cutaneous) reflexes are the more commonly tested in clinical practice. A wooden stick or pin is used to scratch the abdomi- nal wall, from the flank to the midline, parallel to the line of the der- matomal strips, in upper (supraumbilical), middle (umbilical), and lower (infraumbilical) areas. The maneuver is best performed at the end of expiration when the abdominal muscles are relaxed, since the reflexes may be lost with muscle tensing; to avoid this, patients should lie supine with their arms by their sides. Superficial abdominal reflexes are lost in a number of circum- stances: normal old age obesity after abdominal surgery after multiple pregnancies in acute abdominal disorders (Rosenbach’s sign). However, absence of all superficial abdominal reflexes may be of localizing value for corticospinal pathway damage (upper motor neu- rone lesions) above T6. Lesions at or below T10 lead to selective loss of the lower reflexes with the upper and middle reflexes intact, in which case Beevor’s sign may also be present. All abdominal reflexes are preserved with lesions below T12. Abdominal reflexes are said to be lost early in multiple sclerosis, but late in motor neurone disease, an observation of possible clinical use, particularly when differentiating the primary lateral sclerosis vari- ant of motor neurone disease from multiple sclerosis.