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Surgical treatment of bladder diverticula Congenital bladder diverticula should only be treated if symptomatic, or if there is concern regarding malignant transformation. Bladder outlet obstruction should be excluded by flow rate or urodynamic studies prior to...

TRACT DYSFUNCTION NLUTD refers to bladder and/or urethral sphincteric disorders that result from neurological lesions. Discrete neurological lesions will a ff ect LUT storage and voiding in a consistent manner depending on the site of the lesion, the nature of...

The micturition cycle The key characteristics of the two phases of the micturition cycle are ( Figure 83.2 ): 1 Urinary storage (filling): /uni25CF low pressure (normal compliance) – dependent on viscoelastic properties of the bladder wall and lack of parasy...

Treatment The cause of the stone should be sought and treated; this may include bladder outlet obstruction, incomplete bladder emptying in patients with neurogenic bladder dysfunction or the presence of a foreign body that should be excised simulta neously (...

Types of catheter Catheters can be classified based on their size (French scale), number of channels or composition (latex-coated or silicone) ( Figure 83.25 ). Size The French scale refers to the external diameter of the cathe ter, and 1Fr is 0.3 /uni00A0 mm...

URINARY INCONTINENCE Urinary incontinence refers to the involuntary leakage of urine. It can be classified into several di ff erent subtypes based on the circumstances leading to episodes of leakage. /uni25CF Stress urinary incontinence (SUI) refers to invol - ...

URINARY RETENTION Urinary retention is defined as the inability to pass urine despite persistent e ff ort. It can be classified as acute (painful inability to pass urine with relief of pain on catheterisation) or chronic (painless, elevated residual volume afte...

URINARY TRACT FISTULAE A fistula is an abnormal or surgically made passage between a hollow or tubular organ and the body surface, or between two hollow or tubular organs. The most common cause of urinary tract fistulae in less economically developed countries i...

URINARY TRACT INFECTION UTI is the inflammatory response of the urothelium to bacte - rial invasion, usually associated with bacteriuria (the presence of bacteria in the urine) and pyuria (the presence of white blood cells in the urine). Pyuria in the absenc...

Urachal anomalies Urachal anomalies are often detected after birth with symptoms of umbilical discharge or bleeding ( Figure 83.10 ). However, asymptomatic urachal anomalies may be incidentally found on abdominal imaging in adults. There are four principal (c...

Urethral catheterisation 1 Aseptic technique – handwashing, sterile gloves, sterile catheter pack. 2 Clean urethral meatus with antiseptic solution. 3 Instil lidocaine gel into the urethra and hold for 2–3 min - utes. In men, the penis should be held perpendic...

Venous drainage V esical plexuses on the lateral and inferior surfaces of the bladder drain into the internal iliac vein (the prostatic plexus in males and the vaginal plexus in females are continuous with the vesical plexus).

Vesicovaginal fistulae VVF is the most common urinary tract fistula. In developing countries, obstetric fistula account for the majority of cases. Lack of adequate prenatal care, younger age at first marriage, short stature, low socioeconomic status and illitera...

cycle Storage phase The storage phase of the micturition cycle requires relaxation of the detrusor to ensure low-pressure filling, and contraction of the smooth and striated muscle of the bladder neck, urethra and external urethral sphincter to ensure conti...

diverticula Bladder diverticula can be congenital or acquired (secondary to infravesical bladder outlet obstruction). Acquired bladder diverticula are most commonly seen in adult men with benign - prostatic obstruction; acquired diverticula can less commonly b...

α -adrenoceptor antagonists 1 The α -adrenoceptor antagonists are commonly used to 1 improve voiding lower urinary tract symptoms (LUTS) in men. Mechanism of action The α -receptors are densely prevalent at the bladder base, 1 bladder neck and proximal urethra...

β -adrenoceptor agonists 3 β -adrenoceptor agonists are relatively new pharmacological 3 agents that are used for the treatment of overactive bladder and neurogenic LUT dysfunction. Mechanism of action Similar to antimuscarinics, the β -agonists are thought t...

ASSESSMENT OF THE PATIENT WITH LOWER URINARY TRACT SYMPTOMS History Symptom score sheets such as the International Prostate Symptom Score (IPSS) assign a score that gives information regarding the severity of symptoms at the outset and changes over time and f...