DOCSLIB.ORG

The Overactive Bladder in Multiple Sclerosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Overactive Bladder in Multiple Sclerosis ronmental component has also been estab- lished. People descended from Scandina- vian countries and colder climates in gen- eral have been reported to have a higher The overactive bladder in incidence of multiple sclerosis. This debil- itating neurologic disease affects 1 of 1000 multiple sclerosis Americans.1,2 Most patients present in the most productive years of life, therefore JARAD S. FINGERMAN, DO making multiple sclerosis even more dev- LEONARD H. FINKELSTEIN, DO, FACOS astating. Multiple sclerosis has been related to an autoimmune attack on the myelin-pro- ducing oligodendrocytes of the central nervous system, causing demyelination of Multiple sclerosis is a common neurologic disorder that often affects the genitouri- the affected nerve. Although there is nary system. One of the most common symptoms of multiple sclerosis is the hyper- preservation of the axon, this demyelina- active bladder. These patients will have symptoms that may affect their lifestyle, such tion results in decreased conduction as urinary incontinence, urgency, and frequency. They may also suffer from debil- through the nerve. The demyelination itating urinary tract symptoms, such as frequent or recurrent urinary tract infections most often affects the posterior and lateral and also on occasion, damage to the upper urinary tract. Fortunately, the neurogenic columns of the cervical spinal cord, but the bladder dysfunction associated with multiple sclerosis can be treated with a reasonable lumbar and sacral cords as well as the chance of success. With proper treatment, related symptoms may be brought under optic nerve, cerebrum, cerebellum, and control, allowing the physician to concentrate on the more debilitating aspects of this brainstem are also commonly involved. disease. The clinical course of multiple sclerosis (Key words: multiple sclerosis, overactive bladdeer, urinary incontinence, is one of relapses and remissions with dis- urgency, frequency, parasympathetic agents, anticholinergic agents, oxybutynin tinct neurologic deficits related to the var- chloride, tolterodine tartrate, propantheline bromide) ious regions affected. Bladder overactivity or illustrative purposes, we describe determined by bladder scan revealed 20 Bladder overactivity is a common disorder. Fthe case of a 36-year-old woman who mL of fluid. Serum chemistry studies It is characterized by involuntary detrusor was seen in the urologist’s office com- revealed normal renal function. Findings contractions that may occur spontaneously plaining of urinary urge incontinence. on renal ultrasound examination were or may be provoked (such as by rapid Three years earlier, multiple sclerosis was also normal, without evidence of renal filling, changes in posture, coughing, walk- diagnosed after she had had visual changes scarring or hydronephrosis. ing, and jumping) while the person is and ataxia. Flexible cystoscopy and urodynamic attempting to suppress them. The over- History revealed that she soaked three evaluation (Figure 1) revealed a first sen- active bladder is referred to as unstable to four pads a day, with significant social sation to void at 30 mL and an uninitiat- when the etiology is nonneurogenic, and impact. Occasional stress incontinence ed detrusor contraction at 80 mL. There as hyperreflexic when the etiology is neu- occurred in which a cough or Valsalva was no involuntary sphincter contraction rogenic. The term overactive bladder refers maneuver would promote a complete mic- at the time of detrusor contraction. These to the storage phase of the bladder only, turition episode. She was able to ambulate findings were consistent with bladder not to micturition (the voiding phase), without significant difficulty, so there was hyperactivity without detrusor-sphincter and is diagnosed by the filling cystometry minimal functional component attributing dyssynergia. phase of urodynamics.3 to her incontinence. The patient was started on oxybutynin Unlike other human visceral systems During a recent hospitalization for chloride (Ditropan) therapy (2.5 mg oral- that require an intact autonomic nervous rehabilitation, an indwelling catheter was ly three times a day), and she was followed system (such as the gastrointestinal and placed and later left in place to control up closely for evidence of urinary reten- cardiovascular systems), the lower uri- her socially debilitating incontinence. tion. She was placed on a timed voiding reg- nary tract depends partly on the voluntary The initial urologic workup revealed imen five times a day. Although her incon- central nervous system to function in the normal findings on urinalysis and negative tinence resolved, close follow-up revealed storage and evacuation of urine. Micturi- culture. Postvoid residual urine volume an increased postvoid residual urine volume tion is under voluntary control and of 100 mL, which eventually normalized. depends on learned behavior that develops She is presently continent with oxybutynin during maturation of the nervous system. From the Department of Urology, Philadelphia College of Osteopathic Medicine (PCOM), and is catheter free. Damage to the brain and spinal cord can where Dr Fingerman is a resident. Dr Finkel- induce bladder overactivity by reducing stein is president and chief executive officer of Multiple sclerosis the parasympathetic inhibition that nor- PCOM. Multiple sclerosis is the most common mally allows the bladder to fill. It has also Correspondence to Jarad S. Fingerman, DO, Department of Urology, 4190 City Ave, neurologic disorder in the 20- to 45-year- been noted that damage to the inhibitory Philadelphia, PA 19131-1695. old age group. There is a 2:1 female-to- axonal pathways in the spinal cord can E-mail: [email protected] male predilection, and a genetic and envi- lead to the emergence and unmasking of Fingerman and Finkelstein • The overactive bladder in multiple sclerosis JAOA • Vol 100 • No 3 • Supplement to March 2000 • S9 by the fact that the urodynamic findings change as the disease waxes and wanes. As the majority of patients have over- active bladder contractions, the inconti- Flow rate nence associated with hyperactivity may (filling) represent the most socially disabling symp- 5 mL/s tom of the disease. Aside from the social aspects of bladder overactivity, it is imper- ative to effectively treat the neurogenic Vesical bladder and the resulting urinary tract (bladder) pressure infections. Many patients with multiple 10 cm H O sclerosis are treated with immunosup- 2 pressive medications, and these infections can lead to devastating complications and sepsis.8 It is therefore quite important that Abdominal pressure physicians diagnose and treat these dis- abling and potentially dangerous condi- 10 cm H2O tions. Treatment Detrusor As already mentioned, the wide array of pressure 10 cm H O urologic symptoms and abnormalities 2 associated with multiple sclerosis poses a therapeutic dilemma. Each patient must have a specific treatment plan aimed toward his or her own objective urody- namic abnormalities. It has been noted Figure 1. Cystometrogram indicating detrusor hyperreflexia. First sensation to void recently that as many as 73% of patients at 15 mL; urgency to void at 34 mL; bladder capacity, 65 mL. with multiple sclerosis without undergo- ing urodynamic evaluation were treated inappropriately.7 As stated earlier, the primitive spinal bladder voiding reflex- patients with multiple sclerosis had detru- majority of patients with multiple sclero- es.4 Upper motor neuron lesions affect- sor hyperreflexia as the primary urody- sis will demonstrate detrusor hyperreflexia ing the genitourinary system can result in namic diagnosis.7 This hyperreflexia com- on cystometric evaluation, but some may bladder hyperactivity and hyperreflexia. monly manifests symptomatically as demonstrate the opposite. The hyperreflexic bladder is one of the urgency, frequency, and generalized “irri- The goals of therapy of the neurogenic most common symptoms of multiple scle- tative” symptoms.7 Very often, there is bladder in multiple sclerosis are conti- rosis. Lower urinary tract symptoms occur associated sphincter dyssynergia, defined nence and, when sphincter dyssynergia is in up to 90% of patients with multiple as simultaneous contractions of the blad- present, reduction of residual urine. A sclerosis at some time in the course of their der and urethral sphincter. This dyssyn- high residual urine volume may cause cys- disease.5 They occur primarily because the ergia can lead to more serious complica- titis, and the upper urinary tract is at risk. neural control system for the urinary blad- tions, as the unstable bladder will contract The use of indwelling urethral or supra- der is distributed throughout the central against a closed urethral sphincter. It can pubic catheters should only be the treat- nervous system. Therefore, clinically, mul- be stated with moderate assurance that ment of last resort, as indwelling catheters tiple sclerosis can manifest itself urologically any patient whose symptom complex con- produce chronic irritation and predispose in many ways. sists of hyperreflexia with an increased the patient to infection, erosion or stricture postvoid residual urine volume has evi- of the urethra, bladder stone formation, Clinical relevance dence of dyssynergia. and possibly malignancy. Between 50% and 90% of all patients The urinary tract symptoms associated Because of acetylcholine-induced stim- with multiple sclerosis complain of voiding with multiple sclerosis vary widely.
Load more

Recommended publications
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • EAU Guidelines on Bladder Stones 2019
    EAU Guidelines on Bladder Stones C. Türk (Chair), A. Skolarikos (Vice-chair), J.F. Donaldson, A. Neisius, A. Petrik, C. Seitz, K. Thomas Guidelines Associate: Y. Ruhayel © European Association of Urology 2019 TABLE OF CONTENTS PAGE 1. INTRODUCTION 3 1.1 Aims and Scope 3 1.2 Panel Composition 3 1.3 Available Publications 3 1.4 Publication History and Summary of Changes 3 1.4.1 Publication History 3 2. METHODS 3 2.1 Data Identification 3 2.2 Review 4 3. GUIDELINES 4 3.1 Prevalence, aetiology and risk factors 4 3.2 Diagnostic evaluation 4 3.2.1 Diagnostic investigations 5 3.3 Disease Management 5 3.3.1 Conservative treatment and Indications for active stone removal 5 3.3.2 Medical management of bladder stones 5 3.3.3 Bladder stone interventions 5 3.3.3.1 Suprapubic cystolithotomy 5 3.3.3.2 Transurethral cystolithotripsy 5 3.3.3.2.1 Transurethral cystolithotripsy in adults: 5 3.3.3.2.2 Transurethral cystolithotripsy in children: 6 3.3.3.3 Percutaneous cystolithotripsy 6 3.3.3.3.1 Percutaneous cystolithotripsy in adults: 6 3.3.3.3.2 Percutaneous cystolithotripsy in children: 6 3.3.3.4 Extracorporeal shock wave lithotripsy (SWL) 6 3.3.3.4.1 SWL in Adults 6 3.3.3.4.2 SWL in Children 6 3.3.4 Treatment for bladder stones secondary to bladder outlet obstruction (BOO) in adult men 7 3.3.5 Urinary tract reconstructions and special situations 7 3.3.5.1 Neurogenic bladder 7 3.3.5.2 Bladder augmentation 7 3.3.5.3 Urinary diversions 7 4.
    [Show full text]
  • Patient Information Bladder Stones Department of Urology
    Patient Information Bladder Stones Department of Urology __________________________________________________________________ Introduction The bladder allows urine to be stored until full and squeezes when you pass urine (urination) allowing it to expel all the urine within it. The waste products in urine can form into crystals in the bladder causing bladder stones to form. Problems can arise if these crystals become too large to be passed out when you urinate or become stuck in the water pipe (urethra). Symptoms Stones in the bladder may not be detected for some time unless they start to cause urinary symptoms - frequently passing urine, blood in the urine, needing to get to the toilet urgently and urine infections. If left, bladder stones can irritate the bladder and cause incontinence (leakage of urine). A stone can get stuck in the urethra and block the emptying of the bladder or the flow of urine may suddenly stop midway. This can cause pain in the back or hips, the tip of the penis or scrotum in men, or the perineum (area between the vagina and the anus) in women. The pain may be dull or sharp and can be made worse by sudden movements and exercise. Causes Change in the acidity of the urine can be enough to make a stone form – a change in acidity is often triggered by an incorrect diet or by not drinking enough fluids. Stagnation of urine in the bladder - diverticulum (a structural abnormality of the bladder), stricture (narrowing in the urethra) and enlargement of the prostate gland can all lead to varying amounts of urine being left in the bladder after urination.
    [Show full text]
  • The Ureteritis Cystica
    Case Report TheScientificWorldJOURNAL (2004) 4 (S1), 175–178 ISSN 1537-744X; DOI 10.1100/tsw.2004.65 A Rare Condition: The Ureteritis Cystica Süleyman Kýlýç1, Semih Yaşar Sargin3, Ali Günes1, Deniz Ipek1, Can Baydinç1, and M. Tayfun Altinok2 Departments of Urology1 and Radiology2; Inonu Universitesi Tip Fakultesi, Turgut Ozal Tip Merkezi, Uroloji AD, Elazig Yolu 9. Km, 44069, Malatya, Turkiye; 3Department of Urology, Yüksek İhtisas Hospital, Ankara, Turkey E-mails: [email protected]; [email protected] Previously published in the Digital Urology Journal DOMAIN: urology CASE PRESENTATIONS Case One In November 1997, a 65-year-old woman was admitted with a complaint of stress urinary incontinence for 2 years. Dysuria, hematuria, and any systemic illness were not noted in her medical history. Physical examination revealed only grade-2 cystocele. Bonney and cotton swab tests were positive. 8-10 erythrocytes and 2-3 leucocytes per high-power field were detected by urine analysis. No bacterial growth was established at midstream urine culture. Blood levels of urea, creatinine, uric acid, and electrolytes were within normal limits. The ultrasonography (USG) of the kidneys and bladder was normal. IVP showed 3 and 4 filling defects in the left and right ureters respectively (Figures 1 and 2). A computerized tomography of the abdomen and pelvis demonstrated an intraluminal lesion in the proximal part of the right ureter that covered the lumen incompletely. A multichannel cystometry confirmed the pure stress incontinence. Cytology findings of selective urine specimens collected from both ureters under local anesthesia were negative for atypical cells. Bilateral rigid ureteroscopies were performed under general anesthesia.
    [Show full text]
  • Microhematuria and Urinary Tract Infections
    1/30/2018 MICROHEMATURIA AND URINARY TRACT INFECTIONS ANEESA HUSAIN, PA-C USMD CANCER CENTER ARLINGTON - UROLOGY I HAVE NO FINANCIAL DISCLOSURES THAT WOULD BE A POTENTIAL CONFLICT OF INTEREST WITH THIS PRESENTATION. MICROHEMATURIA TOPICS OF DISCUSSION • DEFINITION • HISTORY • PHYSICAL EXAM • DIFFERENTIAL DIAGNOSES • WORK UP • TREATMENT • WHEN TO REFER? 1 1/30/2018 MICROHEMATURIA DEFINED AS.. • ≥3 RBCs per HPF (HIGH POWER FIELD) ON URINE MICROSCOPY • SHOULD NOT BASE SOLELY ON ONE DIPSTICK READING • CAN CORRELATE TO DIPSTICK URINE ANALYSIS • TRACE, SMALL, MODERATE, LARGE https://www.auanet.org/guidelines/asymptomatic-microhematuria-(2012-reviewed-and-validity-confirmed-2016) MICROHEMATURIA TOP DIFFERENTIAL DIAGNOSES • UTI/PROSTATITIS • KIDNEY STONES • URINARY TRACT OBSTRUCTION • URINARY TRACT MALIGNANCY • NEPHROLOGIC SOURCES MICROHEMATURIA HISTORY • NEW DIAGNOSIS OF MICROHEMATURIA? • PRIOR HISTORY OF GROSS OR MICROHEMATURIA? • PRIOR WORK UP • COMORBIDITIES • PELVIC RADIATION • SURGICAL HISTORY • FOR WOMEN, ASK ABOUT MENSES AND/OR MENOPAUSE • ANTICOAGULATION OR BLOOD THINNERS • SYMPTOMS 2 1/30/2018 MICROHEMATURIA HISTORY - SYMPTOMS • DYSURIA • FREQUENCY • URGENCY • DIFFICULTY VOIDING • INCONTINENCE – PAD USAGE • ABDOMINAL OR BACK PAIN • PERINEAL PAIN MICROHEMATURIA PHYSICAL EXAM • ABDOMINAL EXAM • CVA/FLANK TENDERNESS • GU EXAM • MALE – CONSIDER MEATAL STENOSIS, BALANITIS, TESTICULAR PAIN, PROSTATITIS, PROSTATE ENLARGEMENT • FEMALE – CONSIDER VAGINAL BLEEDING, YEAST INFECTION, ATROPHIC VAGINITIS MICROHEMATURIA DIFFERENTIAL DIAGNOSES • UTI/PROSTATITIS
    [Show full text]
  • 653 Location of the Desire to Void and Urinary Urgency In
    653 Akino H1, Yokokawa R1, Matsuta Y1, Ito H1, Oyama N1, Nojiri M2, Yokoyama O1 1. Department of Urology, University of Fukui, 2. Hayashi Hospital LOCATION OF THE DESIRE TO VOID AND URINARY URGENCY IN MALE PATIENTS WITH LOWER URINARY TRACT SYMPTOMS Hypothesis / aims of study In patients with overactive bladder syndrome (OAB), it is said that urgency is usually described as being felt lower down than the sensations of bladder filling and the normal desire to void. However, only two articles have recently described the location of recalled sensation and that of induced sensation during filling cystometry in female OAB patients [1, 2]. There has been little information about the location of the desire to void or that of urinary urgency in male OAB patients as well as about the association between them and the severity of OAB symptoms or that of lower urinary tract symptoms (LUTS). The aim of this study was to determine the locations of the desire to void and urinary urgency in male LUTS patients, and correlate them with the severity of OAB and LUTS. Study design, materials and methods Twenty-three consecutive male patients with LUTS older than 50 years old who visited our out-patient clinic and 10 male asymptomatic controls were enrolled. The LUTS patients were excluded if they had urinary tract infection, bladder stone, neurogenic bladder and the malignant tumor of the bladder or prostate. The LUTS patients and controls were asked to describe the location of their strong desire to void (SDV), and also that of urgency if they were experiencing urgency.
    [Show full text]
  • Coexistence of Multiple Ureteral and Ureterocele Stones in a Patient
    Turkyilmaz et al. Afr J Urol (2020) 26:20 https://doi.org/10.1186/s12301-020-00032-x African Journal of Urology CASE REPORTS Open Access Coexistence of multiple ureteral and ureterocele stones in a patient Zafer Turkyilmaz1,2, Suleyman Yesil1,2, Ramazan Karabulut1,2*, Fazli Polat1,2, Kivanc Seref1,2, Hayrunnisa Oral1,2 and Kaan Sonmez1,2 Abstract Background: Uroterocele causes atony and stagnation in the ureter, thus predisposing the patient to stone forma- tion. Multiple calculi in uroteroceles are common in adults but very rare in children. Case presentation: We describe the case of a 3-year-old boy who presented with hematuria and was found to have multiple ureteral and ureterocele stones. The diagnosis was made during endoscopic lithotripsy. A holmium/yttrium– aluminum–garnet (Ho–YAG) laser was used to excise the uroterocele and for lithotripsy. Conclusions: In appropriate cases, minimally invasive techniques, for example, Ho–YAG laser lithotripsy and uretero- cele excision may be preferred. Keywords: Ureterocele, Ureter, Stone, Laser lithotripsy 1 Background ureter, it showed a 4 mm × 24 mm opacity, as well as an A ureterocele is a dilation of the submucosal ureter due 11 × 6 mm opacity extending into the bladder adjacent to a delay in Chawall’s membrane absorption. Tis anom- to the frst opacity (Fig. 1). Transurethral lithotripsy was aly causes atony and stagnation in the ureter, thus pre- performed. During the cystoscopy procedure, no left ure- disposing the patient to stone formation [1]. Ureteroceles teral orifce was observed. However, a balloon-like uret- and stone association is common in adults but rarely seen erocele containing numerous millimeter-sized stones was in children [2].
    [Show full text]
  • Supplementary Table 1. Specific KCD Code of Major Urologic Disease
    Suh et al. Investig Clin Urol 2017;58:281-288. July 2017. https://doi.org/10.4111/icu.2017.58.4.281 Supplementary Table 1. Specific KCD code of major urologic disease Major urologic problem Specific conditions KCD code Benign prostatic hyperplasia N40 BPH without obstruction N400 BPH with obstruction N401 BPH with hematuria N402 BPH with obstruction and hematuria N403 BPH with other complication N408 Overactive bladder and urinary incontinence Overactive bladder N328 Urinary incontinence R32 Stress urinary incontinence N393 Urgency incontinence N3940 Mixed incontinence N3941 Other specified urinary incontinence N3948 Neurogenic bladder Reflex neuropathic bladder, NEC N311 Neurogenic bladder dysfunction, NOS N319 Flaccid neuropathic bladder, NEC N312 Supplementary Table 2. Specific KCD code of complications Complication Specific conditions KCD code Prostatitis Prostatitis N419 Acute prostatitis w/o hematuria N4100 Acute prostatitis with hematuria N4101 Chronic prostatitis w/o hematuria N4110 Chronic prostatitis with hematuria N4111 Granulomatous prostatitis N4180 Other prostatitis N4188 Prostatic abscess N412 Gonococcal prostatitis A542 Trichomonal prostatitis A5901 Acute and chronic urinary retention Retention of urine R33 Urinary tract infection N390 Pyelonephritis Acute/emphysematous pyelonephritis N10 Chronic pyelonephritis N119 Chronic pyelonephritis associated with VUR N110 Chronic obstructive pyelonephritis N111 Pyelonephritis N12 Xanthogranulomatous pyelonephritis N118 Cystitis Interstitial cystitis N300 Chronic cystitis N301 Cystitis
    [Show full text]
  • Urinary Retention
    Urinary Retention National Kidney and Urologic Diseases Information Clearinghouse What is urinary retention? What is the urinary tract Urinary retention is the inability to and how does it work? empty the bladder completely. Urinary The urinary tract is the body’s drainage retention can be acute or chronic. Acute system for removing urine, which is urinary retention happens suddenly and composed of wastes and extra fluid. In lasts only a short time. People with acute order for normal urination to occur, all urinary retention cannot urinate at all, body parts in the urinary tract need to work even though they have a full bladder. together in the correct order. Acute urinary retention, a potentially life-threatening medical condition, Kidneys. The kidneys are two bean-shaped requires immediate emergency treatment. organs, each about the size of a fist. They Acute urinary retention can cause great are located just below the rib cage, one discomfort or pain. on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of Chronic urinary retention can be a long- blood to produce about 1 to 2 quarts of lasting medical condition. People with urine. The kidneys work around the clock; chronic urinary retention can urinate. a person does not control what they do. However, they do not completely empty all of the urine from their bladders. Ureters. Ureters are the thin tubes of Often people are not even aware they muscle—one on each side of the bladder— have this condition until they develop that carry urine from each of the kidneys to another problem, such as urinary the bladder.
    [Show full text]
  • The Bladder in MS
    ogy & N ol eu ur e ro N p h f y o s l Sammarco, et al., J Neurol Neurophysiol 2014, 5:3 i o a l n o r g u y o DOI: 10.4172/2155-9562.1000200 J Journal of Neurology & Neurophysiology ISSN: 2155-9562 Review Article Open Access The Bladder in MS: A Review Anne G Sammarco*, Bogdan Orasanu and Sangeeta T Mahajan University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA *Corresponding author: Anne G Sammarco, University Hospitals Case Medical Center, Obstetrics and Gynecology, 11100 Euclid Ave, Cleveland, Ohio 44106, USA, Tel: 513-520-8000; E-mail: [email protected] Rec Date: Dec 17, 2013, Acc Date: Mar 20, 2014, Pub Date: Mar 26, 2014 Copyright: © 2014 Sammarco AG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Urinary complaints are common in Multiple Sclerosis (MS), representing a large source of morbidity and financial burden for these patients. These issues can be complex and difficult to manage for the care provider. As new treatments develop, it is important to have a structured but flexible approach to the diagnosis and treatment of urinary symptoms. In this article we review the pathophysiology, symptoms, work up, and management options for the bladder in MS. Keywords: Multiple sclerosis; Urinary incontinence; Neurogenic (S2-S4), the detrusor muscle is inhibited, promoting bladder bladder relaxation. As bladder filling continues, increased afferent neuron firing within Background the pelvic nerve activates the spinobulbospinal reflex pathway which Multiple Sclerosis (MS) is a progressive inflammatory relays neurons through the periaqueductal grey (PAG) to the pontine demyelinating disease of the central nervous system well known to micturition center (PMC).
    [Show full text]
  • Bladder Stones
    BLADDER STONES What are bladder stones? Bladder stones (uroliths or cystic calculi) are rock-like collections of minerals that form in the urinary bladder. They may occur as a large, single stone or as collections of stones the size of large grains of sand or gravel. Are these the same as gall stones or kidney stones? No. Gallstones are in the gall bladder located near the liver, and kidney stones are in the kidney. Although the kidneys and urinary bladder are both part of the urinary system, kidney stones are usually unrelated to bladder stones. What problems do bladder stones cause? The two most common signs of bladder stones are hematuria (blood in the urine) and dysuria (straining to urinate). Hematuria occurs because the stones irritate the bladder wall causing bleeding. Dysuria occurs when stones obstruct the flow of urine out of the bladder. Large stones may cause a partial obstruction at the point where the urine leaves the bladder and enters the urethra; small stones may flow with the urine into the urethra and cause an obstruction there. When an obstruction occurs, the bladder cannot be emptied and this is very painful. Your dog may cry in pain, especially if pressure is applied to the abdominal wall. Hematuria and dysuria are the most common signs seen in dogs with bladder stones but with obstruction there is also pain. We know this because when bladder stones are removed surgically, many owners tell us how much better and more active their dog feels. Why do they form? There are several theories of bladder stone formation.
    [Show full text]