Detrusor instability - current management

Article Abstract:

An unstable bladder causes the involuntary release of urine when the muscle surrounding the bladder, the detrusor, contracts spontaneously. Unstable bladders can be caused by a neurological problem or, as in most cases, for no known reason (idiopathic detrusor instability). Detrusor instability primarily affects elderly women. Current treatments, aimed at returning control of the central reflex or blocking the nerves supplying the bladder, are not very effective. Initial treatment can include behavior modification, a method of suppressing detrusor muscle contractions by retraining the individual with bladder drills, biofeedback, hypnotherapy and acupuncture. Although these methods are effective, relief of symptoms is temporary. The objective of therapy with drugs is to stop neurotransmitting chemicals from reaching the receptors on the bladder (using anticholinergic agents) or to relax the detrusor muscle. Tricyclic antidepressants and calcium channel blockers are drugs that have anticholinergic properties, among others. Oxybutynin is an agent that is very effective in reducing urinary frequency and urgency, but is associated with some intolerable side effects, such as severe mouth dryness. Other treatments include antidiuretic hormone, which decreases urinary incontinence at night, and estrogen replacement therapy, which may help raise the sensory threshold of the bladder to reduce nighttime leakage. For women who do not respond to combined behavioral and drug therapy, surgery may provide some improvement in symptoms. Intractable detrusor instability can be treated by the 'clam' augmentation enterocystoplasty, a procedure that redirects urine to the intestines. For most however, detrusor instability is an annoyance rather than a disability. Since the disease periodically goes into remission, treatment may only be needed on a short-term basis. Although there is no real cure, some form of treatment can improve the quality of life for most patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bladder

---

Symptoms analysis for the diagnosis of genuine stress incontinence

Article Abstract:

Urinary incontinence is the inability to retain urine, usually due to impaired function of the sphincter, a circular muscle that prevents urine outflow. The most common form of this urinary disorder in women is genuine stress incontinence, the inability to retain urine during times of physiological stress, such as laughing, coughing, sneezing, lifting, or sudden movement. Genuine stress incontinence can be treated by surgery to repair the neck of the bladder. Studies suggest that this disorder is not always correctly diagnosed by analysis of symptoms alone. Urodynamic studies are needed to assess the ability of the bladder to hold or store and empty urine, and thereby confirm a diagnosis of genuine stress incontinence. Most patients with genuine stress incontinence also have symptoms of other disorders. However, the equipment and staff needed to perform urodynamic studies are costly, and the necessity of these studies requires evaluation. The accuracy of diagnosing genuine stress incontinence based on symptoms alone was assessed. To eliminate the possibility of human error, a computer was used to determine the clinical diagnosis. A mathematical model was used to separate patients with an impaired urethral sphincter from those with an intact sphincter. The study involved 252 patients who were asked to answer a questionnaire dealing with 20 symptoms of impaired function of the lower urinary tract. The patients also underwent various tests of urinary function. Genuine stress incontinence was correctly diagnosed based on symptoms alone in 81 percent of cases and misdiagnosed in 16 percent of cases. These findings suggest that women with symptoms of genuine stress incontinence should be assessed further by urodynamic studies before undergoing surgical treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Testing, Urinary stress incontinence, Symptomatology, Signs and symptoms, Urination disorders

---

Bladder neck electrical conductivity in the treatment of detrusor instability with biofeedback

Article Abstract:

Instability of the detrusor muscle, the muscle layer surrounding the bladder, causes urinary incontinence in women. Bladder control is aided by drug therapy and by retraining the bladder. A method of biofeedback training to control symptoms of detrusor instability was developed. The activity of the bladder neck was monitored using a conductivity catheter, which is a small tube that was inserted into the bladder neck, where detrusor pressure during bladder filling was measured. Ten women with severe detrusor instability were asked to create a mental picture of decreasing the bladder neck. Symptoms of urgency and incontinence, which were evaluated before and after biofeedback treatment, decreased after biofeedback training. Results of cystometry, a study of bladder functioning, also showed improvements in 5 out of 10 women. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Biofeedback training, Biofeedback

Similar abstracts:

• Abstracts: Vision-related problems may offer clues for earlier diagnosis of Alzheimer's disease. Consensus statements: applying structure
• Abstracts: Depression, affect and negative symptoms in schizophrenia. The prognostic significance of negative symptoms in schizophrenia
• Abstracts: Recurrent Paget disease of the vulva in a split-thickness graft. Use of ultrasonography in the difficult postmenopausal dilation and curettage
• Abstracts: Factors affecting recurrence in lumpectomy without irradiation for breast cancer. Impact of radiation therapy and/or chemotherapy on the risk for a second malignancy after breast cancer
• Abstracts: Diagnosis and management of subglottic stenosis after neonatal ventilation. Multicentre randomised controlled trial of high against low frequency positive pressure ventilation

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.