NEUROGENIC BLADDER. Dr Harriet Grubb Dr Alison Seymour Dr Alexander Joseph

Size: px
Start display at page:

Download "NEUROGENIC BLADDER. Dr Harriet Grubb Dr Alison Seymour Dr Alexander Joseph"

Transcription

1 NEUROGENIC BLADDER Dr Harriet Grubb Dr Alison Seymour Dr Alexander Joseph

2 OUTLINE Definition Anatomy and physiology of bladder function Types of neurogenic bladder Assessment and management Complications of neurogenic bladder

3 NEUROGENIC BLADDER Disorder of the lower urinary tract Caused by central and/or peripheral nervous system damage or disease

4 SCHEMATIC DIAGRAM OF THE LOWER URINARY TRACT Ureter Detrusor Muscle of the Bladder Internal Urethral Sphincter External Urethral Sphincter

5 STORAGE VOIDING

6 AREAS OF THE NERVOUS SYSTEM INVOLVED WITH MICTURITION BRAIN BRAINSTEM CERVICAL SPINAL CORD C1-C8 THORACIC SPINAL CORD T1-T12 LUMBAR SPINAL CORD L1-L5 SACRAL SPINAL CORD S1-S5 BRAIN PONTINE MICTURITION CENTRE THORACOLUMBAR REGION T11-L2 SACRAL MICTURITION CENTRE S2-S4

7 NERVES ORIGINATING FROM SACRAL MICTURITION CENTRE Pelvic nerve Parasympathetic Acetylcholine SMC S2-S4

8 NERVES ORIGINATING FROM SACRAL MICTURITION CENTRE Pudendal nerve Somatic Acetylcholine SMC S2-S4

9 NERVES ORIGINATING FROM THORACOLUMBAR REGION T11-L2 Hypogastric nerve Sympathetic Noradrenaline Thoraco -lumbar region T11- L2

10 NERVES ORIGINATING FROM THORACOLUMBAR REGION T11-L2 Hypogastric nerve Sympathetic Noradrenaline Thoraco -lumbar region T11-L2

11 PMC PONTINE MICTURITION CENTRE

12 BRAIN

13 BRAIN

14 BLADDER STORAGE

15 VOIDING

16 TYPES OF NEUROGENIC BLADDER LESIONS ABOVE THE PONTINE MICTURITION CENTRE Uninhibited bladder Cortex no longer has inhibitory control of PMC Frequency Reduced awareness of bladder fullness Uncontrolled and potentially socially unacceptable voiding

17 TYPES OF NEUROGENIC BLADDER LESIONS BETWEEN PMC AND SMC Upper motor neurone bladder Loss of inhibition from higher centres Emptying via spinal reflex

18 Spinal Reflex of bladder emptying following spinal cord lesion SMC

19 TYPES OF NEUROGENIC BLADDER LESIONS BETWEEN PMC AND SMC Lack of inhibition from brain and PMC leads to overactivity and hyper-reflexive Urgency Frequency Incontinence Reduced bladder capacity

20 TYPES OF NEUROGENIC BLADDER LESIONS BETWEEN PMC AND SMC Initial spinal shock (typically 6-12 weeks) Areflexia Urinary retention No awareness of bladder filling

21 TYPES OF NEUROGENIC BLADDER LESIONS BETWEEN PMC AND SMC Detrusor Sphincter Dyssynergia (DSD) Pudendal nerves also involved in spinal reflex contraction of external urethral sphincter (EUS) Loss of co-ordination between detrusor muscle and EUS If simultaneous contraction high bladder pressures Voiding interrupted or incomplete Incontinence Complications vesico-ureteric reflux

22 TYPES OF NEUROGENIC BLADDER LESIONS BELOW THE SPINAL CORD The nerves roots are affected causing a lower motor neurone lesion Pelvic nerve damage inhibits contraction of the detrusor muscle Hypogastric nerves are still intact also having a relaxing affect on the detrusor Internal sphincter is still contracted from the hypogastric nerve Flaccid/areflexic bladder Bladder distension and overflow incontinence

23 TYPES OF NEUROGENIC BLADDER In practice many patients have a mixed picture of bladder problems, particularly if the injury is around sacral/conus regions of the spinal cord

24 ASSESSMENT

25 ASSESSMENT AND MANAGEMENT OF NEUROGENIC BLADDER

26 ASSESSMENT History should include: Urinary tract symptoms storage/emptying/both Neurological symptoms and diagnosis Bowel symptoms Examination: Blood pressure Abdominal examination External genitalia Focused neurological examination

27 RED FLAG SYMPTOMS Haematuria Recurrent UTIs Loin pain Recurrent catheter blockages Hydronephrosis or kidney stones Deterioration in kidney function Urgent urology referral

28 INVESTIGATIONS Urine dip +/- MSU or CSU Bladder diary Post void bladder scan If high risk of renal complications: Renal ultrasound Urodynamics Cystoscopy

29 MANAGEMENT OF STORAGE SYMPTOMS

30 MANAGEMENT General advice: Avoidance of bladder irritants Maintaining good fluid intake Avoiding constipation Medications

31 Medications for neurogenic bladder Beta 3 agonist STORAGE Hypogastric nerve Sympathetic Noradrenaline Antimuscarinics Thoraco -lumbar region T11- L2 VOIDING Alpha blockers

32 ANTIMUSCARINICS Main medications used are: Solifenacin Oxybutinin Tolderidone Darifenacin Trospium Fesoterodine

33 BOTULINUM TOXIN Licenced for use if antimuscarinic treatment has failed Patients may require a catheterisation regime following treatment as bladder emptying impaired Injected directly into bladder wall under cystoscopy guidance

34 MANAGEMENT OF VOIDING SYMPTOMS

35 FAILURE OF BLADDER EMPTYING Intermittent self-catheterisation Indwelling urethral catheter Suprapubic catheter

36 COMPLICATIONS OF NEUROGENIC BLADDER

37 URINARY TRACT INFECTIONS Most common cause of sepsis in patients with spinal cord injury More likely if: Infrequent ISC Assisted intermittent catheterisation Indwelling catheter Avoid treating asymptomatic bacteriuria

38 URINARY CALCULI Suspect if: Recurrent UTIs Recurrent catheter blockages Haematuria Can lead to ureteral obstruction and hydronephrosis

39 VESICOURETERAL REFLUX Due to persistently high bladder pressures and detrusorsphincter dyssynergia Can lead to pyelonephritis, hydronephrosis and renal impairment

40 BLADDER CANCER Those at risk include those with long-standing symptoms or recurrent UTI Patients with red-flag symptoms should be referred for urgent urology assessment

41 THANK YOU FOR LISTENING

42 REFERENCES Wein AJ, Rackley RR. Overactive bladder a better understanding of Pathophysiology, Diagnosis and Management. Journal of Urology 2006:175;S5-S10 Abrams GM, Wakasa M. Chronic complications of spinal cord injury and disease. Available from URL: National Institute of Health and Care Excellence Urinary incontinence in neurological disease: assessment and management. Available from URL: Fowler CJ, O Malley KJ. Investigation and Management of Neurogenic Bladder Dysfunction. J Neurol Neurosurg Psychiatry 2003;74:iv27-iv31

43 REFERENCES Neurogenic Bladder Review Article - Peter Dorsher and Peter McIntosh Advances in Urology Vol Article ID Neuro-urology guidelines - European association of Urology The Epidemiology and Pathophysiology of Neurogenic Bladder - David Ginsberg International Continence Society Fact sheets - August 2015 Physiology of Micturition - Armando Hasudungan The prognosis and Management of Neurogenic Bladder University of Michigan Health System Management of Neurogenic Bladder for Adults with Spinal Cord Injuries ACI NSW Agency for Clinical Innovation

The Neurogenic Bladder

The Neurogenic Bladder The Neurogenic Bladder Outline Brandon Haynes, MD Resident Physician Department of Urology Jelena Svircev, MD Assistant Professor Department of Rehabilitation Medicine Anatomy and Bladder Physiology Bladder

More information

Neuropathic Bladder. Magda Kujawa Consultant Urologist Stockport NHS Foundation Trust 12/03/2014

Neuropathic Bladder. Magda Kujawa Consultant Urologist Stockport NHS Foundation Trust 12/03/2014 Neuropathic Bladder Magda Kujawa Consultant Urologist Stockport NHS Foundation Trust 12/03/2014 Plan Physiology- bladder and sphincter behaviour in neurological disease Clinical consequences of Symptoms

More information

Urodynamics in Neurological Lower Urinary Tract Dysfunction. Mr Chris Harding Consultant Urologist Freeman Hospital Newcastle-upon-Tyne

Urodynamics in Neurological Lower Urinary Tract Dysfunction. Mr Chris Harding Consultant Urologist Freeman Hospital Newcastle-upon-Tyne Urodynamics in Neurological Lower Urinary Tract Dysfunction Mr Chris Harding Consultant Urologist Freeman Hospital Newcastle-upon-Tyne Learning Objectives Review functional neurology relevant to lower

More information

Summary. Neuro-urodynamics. The bladder cycle. and voiding. 14/12/2015. Neural control of the LUT Initial assessment Urodynamics

Summary. Neuro-urodynamics. The bladder cycle. and voiding. 14/12/2015. Neural control of the LUT Initial assessment Urodynamics Neuro-urodynamics Summary Neural control of the LUT Initial assessment Urodynamics Marcus Drake, Bristol Urological Institute SAFETY FIRST; renal failure, dysreflexia, latex allergy SYMPTOMS SECOND; storage,

More information

Lower Urinary Tract Symptoms K Kuruvilla Zachariah Associate Specialist

Lower Urinary Tract Symptoms K Kuruvilla Zachariah Associate Specialist Lower Urinary Tract Symptoms K Kuruvilla Zachariah Associate Specialist Lower Urinary Tract Symptoms Storage Symptoms Frequency, urgency, incontinence, Nocturia Voiding Symptoms Hesitancy, poor flow, intermittency,

More information

Incontinence in neurological disease

Incontinence in neurological disease nice bulletin Incontinence in neurological disease NICE provided the content for this booklet which is independent of any company or product advertised NICE Bulletin - Incontinence in neurological disease.indd

More information

Bladder dysfunction in ALD and AMN

Bladder dysfunction in ALD and AMN Bladder dysfunction in ALD and AMN Sara Simeoni, MD Department of Uro-Neurology National Hospital for Neurology and Neurosurgery Queen Square, London 10:15 Dr Sara Simeoni- Bladder issues for AMN patients

More information

Spinal Cord Injury. R Hamid Consultant Neuro-Urologist London Spinal Injuries Unit, Stanmore & National Hospital for Neurology & Neurosurgery, UCLH

Spinal Cord Injury. R Hamid Consultant Neuro-Urologist London Spinal Injuries Unit, Stanmore & National Hospital for Neurology & Neurosurgery, UCLH Spinal Cord Injury R Hamid Consultant Neuro-Urologist London Spinal Injuries Unit, Stanmore & National Hospital for Neurology & Neurosurgery, UCLH SCI 800 1000 new cases per year in UK Car accidents 35%

More information

Bladder Management. A guide for patients. Key points

Bladder Management. A guide for patients. Key points Bladder Management A guide for patients Key points Urinary issues remain one of the highest causes of readmission to hospital following Spinal Cord Injury (SCI). Following SCI most patients experience

More information

TREATMENT METHODS FOR DISORDERS OF SMALL ANIMAL BLADDER FUNCTION

TREATMENT METHODS FOR DISORDERS OF SMALL ANIMAL BLADDER FUNCTION Vet Times The website for the veterinary profession https://www.vettimes.co.uk TREATMENT METHODS FOR DISORDERS OF SMALL ANIMAL BLADDER FUNCTION Author : SIMONA T RADAELLI Categories : Vets Date : July

More information

Guidelines on Neurogenic Lower Urinary Tract Dysfunction

Guidelines on Neurogenic Lower Urinary Tract Dysfunction Guidelines on Neurogenic Lower Urinary Tract Dysfunction (Text update March 2009) M. Stöhrer (chairman), B. Blok, D. Castro-Diaz, E. Chartier- Kastler, P. Denys, G. Kramer, J. Pannek, G. del Popolo, P.

More information

Overactive Bladder Syndrome

Overactive Bladder Syndrome Overactive Bladder Syndrome behavioural modifications to pharmacological and surgical treatments Dr Jos Jayarajan Urologist Austin Health, Eastern Health Warringal Private, Northpark Private, Epworth Overactive

More information

Lower Urinary Tract Symptoms (LUTS) and Nurse-Led Clinics. Sean Diver Urology Advanced Nurse Practitioner candidate Letterkenny University Hospital

Lower Urinary Tract Symptoms (LUTS) and Nurse-Led Clinics. Sean Diver Urology Advanced Nurse Practitioner candidate Letterkenny University Hospital Lower Urinary Tract Symptoms (LUTS) and Nurse-Led Clinics Sean Diver Urology Advanced Nurse Practitioner candidate Letterkenny University Hospital 01/02/2018 Lower Urinary Tract Symptoms LUTS - one of

More information

Renal Physiology: Filling of the Urinary Bladder, Micturition, Physiologic Basis of some Renal Function Tests. Amelyn R.

Renal Physiology: Filling of the Urinary Bladder, Micturition, Physiologic Basis of some Renal Function Tests. Amelyn R. Renal Physiology: Filling of the Urinary Bladder, Micturition, Physiologic Basis of some Renal Function Tests Amelyn R. Rafael, MD 1 Functions of the Urinary Bladder 1. storage of urine 150 cc 1 st urge

More information

Physiology & Neurophysiology of lower U.T.

Physiology & Neurophysiology of lower U.T. Physiology & Neurophysiology of lower U.T. Classification of voiding dysfunction Evaluation of a child with voiding dysfunction Management Storage Ø Adequate volume of urine Ø At LOW pressure Ø With NO

More information

Clinical guideline Published: 8 August 2012 nice.org.uk/guidance/cg148

Clinical guideline Published: 8 August 2012 nice.org.uk/guidance/cg148 Urinary incontinence in neurological disease: assessment and management Clinical guideline Published: 8 August 2012 nice.org.uk/guidance/cg148 NICE 2018. All rights reserved. Subject to Notice of rights

More information

Management of OAB. Lynsey McHugh. Consultant Urological Surgeon. Lancashire Teaching Hospitals

Management of OAB. Lynsey McHugh. Consultant Urological Surgeon. Lancashire Teaching Hospitals Management of OAB Lynsey McHugh Consultant Urological Surgeon Lancashire Teaching Hospitals Summary Physiology Epidemiology Definitions NICE guidelines Evaluation Conservative management Medical management

More information

Neurogenic bladder. Neurogenic bladder is a type of dysfunction of the bladder due to neurological disorder.

Neurogenic bladder. Neurogenic bladder is a type of dysfunction of the bladder due to neurological disorder. Definition: Neurogenic bladder Neurogenic bladder is a type of dysfunction of the bladder due to neurological disorder. Types: Nervous system diseases: Congenital: like myelodysplasia like meningocele.

More information

Overactive Bladder: Diagnosis and Approaches to Treatment

Overactive Bladder: Diagnosis and Approaches to Treatment Overactive Bladder: Diagnosis and Approaches to Treatment A Hidden Condition* Many Many patients self-manage by voiding frequently, reducing fluid intake, and wearing pads Nearly Nearly two-thirds thirds

More information

Pelvic Floor Therapy for the Neurologic Client Carina Siracusa, PT, DPT, WCS

Pelvic Floor Therapy for the Neurologic Client Carina Siracusa, PT, DPT, WCS Pelvic Floor Therapy for the Neurologic Client Carina Siracusa, PT, DPT, WCS OhioHealth, Columbus Ohio Disclosures I have nothing to disclose Objectives Describe the role of a pelvic floor therapist in

More information

[Type text] TELE-REHABILITATION GUIDELINE Neurogenic Bladder Management in Spinal Cord Injuries Drafted: 2014 Peer Reviewed: Finalized: June 2014

[Type text] TELE-REHABILITATION GUIDELINE Neurogenic Bladder Management in Spinal Cord Injuries Drafted: 2014 Peer Reviewed: Finalized: June 2014 TELE-REHABILITATION GUIDELINE Neurogenic Bladder Management in Spinal Cord Injuries Drafted: 2014 Peer Reviewed: Finalized: June 2014 70-84% of people with SCI will have some level of bladder dysfunction

More information

Signal transduction underlying the control of urinary bladder smooth muscle tone Puspitoayu, E.

Signal transduction underlying the control of urinary bladder smooth muscle tone Puspitoayu, E. UvA-DARE (Digital Academic Repository) Signal transduction underlying the control of urinary bladder smooth muscle tone Puspitoayu, E. Link to publication Citation for published version (APA): Puspitoayu,

More information

Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline.

Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. TARGET POPULATION Eligibility Decidable (Y or N) Inclusion Criterion non-neurogenic OAB Exclusion Criterion

More information

UK Consensus on Bladder Management in MS

UK Consensus on Bladder Management in MS Continence Care Forum Annual Conference UK Consensus on Bladder Management in MS Clare J.Fowler National Hospital for Neurology and Neurosurgery & Institute of Neurology, UCL Association of British Neurologists

More information

Dysfunctional voiding

Dysfunctional voiding Dysfunctional voiding The importance of assessment, diagnosis and treatment of dysfunctional voiding and its role in recurrent UTI Dr Dean Wallace Consultant Paediatric Nephrologist RMCH Objectives Development

More information

GUIDELINES ON NEUROGENIC LOWER URINARY TRACT DYSFUNCTION

GUIDELINES ON NEUROGENIC LOWER URINARY TRACT DYSFUNCTION GUIDELINES ON NEUROGENIC LOWER URINARY TRACT DYSFUNCTION M. Stöhrer (chairman), D. Castro-Diaz, E. Chartier-Kastler, G. Kramer, A. Mattiasson, J-J. Wyndaele Introduction NLUTD (neurogenic lower urinary

More information

Mr. GIT KAH ANN. Pakar Klinikal Urologi Hospital Kuala Lumpur.

Mr. GIT KAH ANN. Pakar Klinikal Urologi Hospital Kuala Lumpur. Mr. GIT KAH ANN Pakar Klinikal Urologi Hospital Kuala Lumpur drgitka@yahoo.com 25 Jan 2007 HIGHLIGHTS Introduction ICS Definition Making a Diagnosis Voiding Chart Investigation Urodynamics Ancillary Investigations

More information

Urodynamic and electrophysiological investigations in neuro-urology

Urodynamic and electrophysiological investigations in neuro-urology Urodynamic and electrophysiological investigations in neuro-urology Pr. Gerard Amarenco Neuro-Urology and Pelvic-Floor Investigations Department Tenon Hospital, Assistance Publique Hôpitaux de Paris, Er6,

More information

CASES FOR TRAINING OF THE INTERNATIONAL SPINAL CORD INJURY LOWER URINARY TRACT FUNCTION BASIC DATA SET CASE 1

CASES FOR TRAINING OF THE INTERNATIONAL SPINAL CORD INJURY LOWER URINARY TRACT FUNCTION BASIC DATA SET CASE 1 1 CASES FOR TRAINING OF THE INTERNATIONAL SPINAL CORD INJURY LOWER URINARY TRACT FUNCTION BASIC DATA SET CASE 1 35 years old man, who previously has been completely healthy, was shot twice in the neck

More information

Neural control of the lower urinary tract in health and disease

Neural control of the lower urinary tract in health and disease Neural control of the lower urinary tract in health and disease Jalesh N. Panicker MD, DM, FRCP Consultant Neurologist and Clinical lead in Uro-Neurology The National Hospital for Neurology and Neurosurgery

More information

Recommandations de prise en charge des vessies neurogènes EAU 2006

Recommandations de prise en charge des vessies neurogènes EAU 2006 Annexe 4-1 Recommandations de prise en charge des vessies neurogènes EAU 2006 (Version courte) 685 686 GUIDELINES ON NEUROGENIC LOWER URINARY TRACT DYSFUNCTION M. Stöhrer (chairman), D. Castro-Diaz, E.

More information

Urinary Aspects of Multiple Sclerosis chronic condition with innovative treatment strategies. Dr. Boris Friedman May 2, 2012 OBJECTIVES

Urinary Aspects of Multiple Sclerosis chronic condition with innovative treatment strategies. Dr. Boris Friedman May 2, 2012 OBJECTIVES Urinary Aspects of Multiple Sclerosis chronic condition with innovative treatment strategies Dr. Boris Friedman May 2, 2012 OBJECTIVES 1) Definition and classification of MS 2) Interventional radiology

More information

Management of Female Stress Incontinence

Management of Female Stress Incontinence Management of Female Stress Incontinence Dr. Arvind Goyal Associate Professor (Urology& Renal Transplant) Dayanand Medical College & Hospital, Ludhiana, Punjab, India Stress Incontinence Involuntary loss

More information

Policy for Prostatism/Lower Urinary Tract Symptoms in men

Policy for Prostatism/Lower Urinary Tract Symptoms in men NHS Halton Clinical Commissioning Group NHS Liverpool Clinical Commissioning Group NHS St Helens Clinical Commissioning Group NHS South Sefton Clinical Commissioning Group NHS Southport and Formby Clinical

More information

Objectives. Key Outlines:

Objectives. Key Outlines: Objectives! Iden8fy and describe the Func8onal Anatomy of Urinary Bladder! Describe the mechanism of filling and emptying of the urinary bladder! Cystometrogram! Appreciate neurogenic control of the mechanism

More information

Stimulation of the Sacral Anterior Root Combined with Posterior Sacral Rhizotomy in Patients with Spinal Cord Injury. Original Policy Date

Stimulation of the Sacral Anterior Root Combined with Posterior Sacral Rhizotomy in Patients with Spinal Cord Injury. Original Policy Date MP 7.01.58 Stimulation of the Sacral Anterior Root Combined with Posterior Sacral Rhizotomy in Patients with Spinal Cord Injury Medical Policy Section Issue 12:2013 Original Policy Date 12:2013 Last Review

More information

Physiologic Anatomy and Nervous Connections of the Bladder

Physiologic Anatomy and Nervous Connections of the Bladder Micturition Objectives: 1. Review the anatomical organization of the urinary system from a physiological point of view. 2. Describe the micturition reflex. 3. Predict the lines of treatment of renal failure.

More information

GUIDELINES ON NEURO-UROLOGY

GUIDELINES ON NEURO-UROLOGY GUIDELINES ON NEURO-UROLOGY (Text update pril 2014) J. Pannek (co-chair), B. Blok (co-chair), D. Castro-Diaz, G. del Popolo, J. Groen, G. Karsenty, T.M. Kessler, G. Kramer, M. Stöhrer Eur Urol 2009 Jul;56(1):81-8

More information

GUIDELINES ON NEURO-UROLOGY

GUIDELINES ON NEURO-UROLOGY GUIDELINES ON NEURO-UROLOGY (Limited text update March 2015) B. Blok (Co-chair), J. Pannek (Co-chair), D. Castro Diaz, G. del Popolo, J. Groen, T. Gross (Guidelines ssociate), R. Hamid, G. Karsenty, T.M.

More information

Regulation of the Urinary Bladder Chapter 26

Regulation of the Urinary Bladder Chapter 26 Regulation of the Urinary Bladder Chapter 26 Anatomy 1. The urinary bladder is smooth muscle lined internally by transitional epithelium and externally by the parietal peritoneum. Contraction of the smooth

More information

Dr Jonathan Evans Paediatric Nephrologist

Dr Jonathan Evans Paediatric Nephrologist How do I manage a patient with intractable daytime wetting: Dr Jonathan Evans Paediatric Nephrologist Of 107 children aged 11-12 with day-wetting 91 (85%) were dry at 15-16 yr Swithinbank et al BJU 1998

More information

Multiple Sclerosis. Véronique Phé, MD, PhD Pitié-Salpêtrière Academic Hospital Department of Urology Paris 6 University Paris, FRANCE

Multiple Sclerosis. Véronique Phé, MD, PhD Pitié-Salpêtrière Academic Hospital Department of Urology Paris 6 University Paris, FRANCE Queen Square Uro-neurology course, London, UK 20 th -21 st October 2016 Multiple Sclerosis Véronique Phé, MD, PhD Pitié-Salpêtrière Academic Hospital Department of Urology Paris 6 University Paris, FRANCE

More information

Objectives. Prevalence of Urinary Incontinence URINARY INCONTINENCE: EVALUATION AND CURRENT TREATMENT OPTIONS

Objectives. Prevalence of Urinary Incontinence URINARY INCONTINENCE: EVALUATION AND CURRENT TREATMENT OPTIONS URINARY INCONTINENCE: EVALUATION AND CURRENT TREATMENT OPTIONS Lisa S Pair, MSN, CRNP Division of Urogynecology and Pelvic Reconstructive Surgery Department of Obstetrics and Gynecology University of Alabama

More information

EAU GUIDELINES ON NEURO-UROLOGY

EAU GUIDELINES ON NEURO-UROLOGY EAU GUIDELINES ON NEURO-UROLOGY (Limited text update March 2017) B. Blok (Co-chair), J. Pannek (Co-chair) D. Castro-Diaz, G. del Popolo, J. Groen, R. Hamid, G. Karsenty, T.M. Kessler Guidelines Associates:

More information

Chapter 23. Micturition and Renal Insufficiency

Chapter 23. Micturition and Renal Insufficiency Chapter 23 Micturition and Renal Insufficiency Voiding Urine Between acts of urination, the bladder is filling. detrusor muscle relaxes urethral sphincters are tightly closed accomplished by sympathetic

More information

Neural control of the lower urinary tract

Neural control of the lower urinary tract Neural control of the lower urinary tract Jalesh N. Panicker Consultant Neurologist and Honorary Senior Lecturer The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology Queen

More information

INVESTIGATION AND MANAGEMENT OF NEUROGENIC BLADDER DYSFUNCTION

INVESTIGATION AND MANAGEMENT OF NEUROGENIC BLADDER DYSFUNCTION INVESTIGATION AND MANAGEMENT OF NEUROGENIC BLADDER DYSFUNCTION See end of article for authors affiliations Correspondence to: Professor Clare Fowler, Department of Uro- Neurology, National Hospital for

More information

Neuropathic bladder and spinal dysraphism

Neuropathic bladder and spinal dysraphism Archives of Disease in Childhood, 1981, 56, 176-180 Neuropathic bladder and spinal dysraphism MALGORZATA BORZYSKOWSKI AND B G R NEVILLE Evelina Children's Department, Guy's Hospital, London SUMMARY The

More information

Incontinence. When I was given this topic in urology to discuss with you today I

Incontinence. When I was given this topic in urology to discuss with you today I Incontinence When I was given this topic in urology to discuss with you today I was slightly disappointed. I personally see mostly men for problems such as stones, benign prostatic hyperplasia, prostate

More information

EAU GUIDELINES ON NEURO-UROLOGY

EAU GUIDELINES ON NEURO-UROLOGY EAU GUIDELINES ON NEURO-UROLOGY (Limited text update March 2016) B. Blok (Co-chair), J. Pannek (Co-chair) D. Castro-Diaz, G. del Popolo, J. Groen, R. Hamid, G. Karsenty, T.M. Kessler. Guidelines Associates:

More information

Urinary Incontinence for the Primary Care Provider

Urinary Incontinence for the Primary Care Provider Urinary Incontinence for the Primary Care Provider Diana J Scott FNP-BC https://youtu.be/gmzaue1ojn4 1 Assessment of Urinary Incontinence Urge Stress Mixed Other overflow, postural, continuous, insensible,

More information

Outcomes In The Urologic Management Of Neurogenic Bladder In Spinal Cord Injured Patients

Outcomes In The Urologic Management Of Neurogenic Bladder In Spinal Cord Injured Patients Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine January 2012 Outcomes In The Urologic Management Of Neurogenic Bladder

More information

Urogynecology in EDS. Joan L. Blomquist, MD Greater Baltimore Medical Center August 2018

Urogynecology in EDS. Joan L. Blomquist, MD Greater Baltimore Medical Center August 2018 Urogynecology in EDS Joan L. Blomquist, MD Greater Baltimore Medical Center August 2018 One in three like me Voiding Issues Frequency/Urgency Urinary Incontinence neurogenic bladder Neurologic supply

More information

Case Based Urology Learning Program

Case Based Urology Learning Program Case Based Urology Learning Program Resident s Corner: UROLOGY Case Number 23 CBULP 2011 077 Case Based Urology Learning Program Editor: Associate Editors: Manager: Case Contributors: Steven C. Campbell,

More information

Neurogenic Bladder. Spina Bifida Education Day Conference SBA of Northeastern New York Albany, New York April 14, Eric Levey, M.D.

Neurogenic Bladder. Spina Bifida Education Day Conference SBA of Northeastern New York Albany, New York April 14, Eric Levey, M.D. Neurogenic Bladder Spina Bifida Education Day Conference SBA of Northeastern New York Albany, New York April 14, 2018 Eric Levey, M.D. Pediatrics & Neurodevelopmental Disabilities Chief Medical Officer,

More information

Oral Nitric Oxide Donors: A New Pharmacological Approach to Detrusor-Sphincter Dyssynergia in Spinal Cord Injured Patients?

Oral Nitric Oxide Donors: A New Pharmacological Approach to Detrusor-Sphincter Dyssynergia in Spinal Cord Injured Patients? European Urology European Urology 45 (24) 516 52 Oral Nitric Oxide Donors: A New Pharmacological Approach to Detrusor-Sphincter Dyssynergia in Spinal Cord Injured Patients? André Reitz a,*, Peter A. Knapp

More information

The Management of Female Urinary Incontinence. Part 1: Aetiology and Investigations

The Management of Female Urinary Incontinence. Part 1: Aetiology and Investigations The Management of Female Urinary Incontinence Part 1: Aetiology and Investigations Dr Oseka Onuma Gynaecologist and Pelvic Reconstructive Surgeon 4 Robe Terrace Medindie SA 5081 Urinary incontinence has

More information

MANAGING BENIGN PROSTATIC HYPERTROPHY IN PRIMARY CARE DR GEORGE G MATHEW CONSULTANT FAMILY PHYSICIAN FELLOW IN SEXUAL & REPRODUCTIVE HEALTH

MANAGING BENIGN PROSTATIC HYPERTROPHY IN PRIMARY CARE DR GEORGE G MATHEW CONSULTANT FAMILY PHYSICIAN FELLOW IN SEXUAL & REPRODUCTIVE HEALTH MANAGING BENIGN PROSTATIC HYPERTROPHY IN PRIMARY CARE DR GEORGE G MATHEW CONSULTANT FAMILY PHYSICIAN FELLOW IN SEXUAL & REPRODUCTIVE HEALTH INTRODUCTION (1) Part of male sexual reproductive organ Size

More information

URINARY TRACT NERVOUS SYSTEM DISORDERS: DRUG THERAPY REVIEW

URINARY TRACT NERVOUS SYSTEM DISORDERS: DRUG THERAPY REVIEW Vet Times The website for the veterinary profession https://www.vettimes.co.uk URINARY TRACT NERVOUS SYSTEM DISORDERS: DRUG THERAPY REVIEW Author : Ian Battersby Categories : Vets Date : August 3, 2009

More information

Post operative voiding dysfunction and the Value of Urodynamics. Dr Salwan Al-Salihi Urogynaecologist Obstetrician and Gynaecologist

Post operative voiding dysfunction and the Value of Urodynamics. Dr Salwan Al-Salihi Urogynaecologist Obstetrician and Gynaecologist Post operative voiding dysfunction and the Value of Urodynamics Dr Salwan Al-Salihi Urogynaecologist Obstetrician and Gynaecologist Learning objectives: v Pathophysiology of post op voiding dysfunction.

More information

Management, Evaluation, and Treatment of Overactive Bladder and Urinary Incontinence

Management, Evaluation, and Treatment of Overactive Bladder and Urinary Incontinence Management, Evaluation, and Treatment of Overactive Bladder and Urinary Incontinence Arthur Mourtzinos, MD, MBA Co-Vice Chair, Institute of Urology Director, Continence Center Assistant Professor of Urology,

More information

INCONTINENCE AND OTHER UROLOGICAL DILEMMAS DR. ANNA LAWRENCE UROLOGIST AUCKLAND HOSPITAL 161 UROLOGY

INCONTINENCE AND OTHER UROLOGICAL DILEMMAS DR. ANNA LAWRENCE UROLOGIST AUCKLAND HOSPITAL 161 UROLOGY INCONTINENCE AND OTHER UROLOGICAL DILEMMAS DR. ANNA LAWRENCE UROLOGIST AUCKLAND HOSPITAL 161 UROLOGY COVERING INCONTINENCE BE ON JUST NAPPIES CATHETERS TYPES AVAILABLE AND WHEN TO USE THEM JJ STENTS???

More information

An Approach to Children with Neurogenic Bladder Dysfunction

An Approach to Children with Neurogenic Bladder Dysfunction Author query: (1) Plz provide citations in text for tables 29.1 to 29.4 and figures 29.1 and 29.2; (2) Plz check the highlighted text for its accuracy 29 CHAPTER An Approach to Children with Neurogenic

More information

Elimination Patterns: Bladder

Elimination Patterns: Bladder Elimination Patterns: Bladder CRRN Review Material Christa Carter, RN, BSN, CRRN Objectives Identify different types of neurogenic bladder Identify different types of incontinence Identify at least three

More information

NEUROMODULATION FOR UROGYNAECOLOGISTS

NEUROMODULATION FOR UROGYNAECOLOGISTS NEUROMODULATION FOR UROGYNAECOLOGISTS Introduction The pelvic floor is highly complex structure made up of skeletal and striated muscle, support and suspensory ligaments, fascial coverings and an intricate

More information

Practical urodynamics What PA s need to know. Gary E. Lemack, MD Professor of Urology and Neurology

Practical urodynamics What PA s need to know. Gary E. Lemack, MD Professor of Urology and Neurology Practical urodynamics What PA s need to know Gary E. Lemack, MD Professor of Urology and Neurology Urodynamics essential elements Urethral catheter Fill rate Catheter size Intravesical pressure measurements

More information

Definitions of IC: U.S. perspective. Edward Stanford MD MS FACOG FACS Western Colorado

Definitions of IC: U.S. perspective. Edward Stanford MD MS FACOG FACS Western Colorado Definitions of IC: U.S. perspective Edward Stanford MD MS FACOG FACS Western Colorado PURPOSE OF A DEFINITION? Identifies with specificity those patients who are most likely to have the disease. Identifies

More information

Technologies and architectures" Stimulator, electrodes, system flexibility, reliability, security, etc."

Technologies and architectures Stimulator, electrodes, system flexibility, reliability, security, etc. March 2011 Introduction" Basic principle (Depolarization, hyper polarization, etc.." Stimulation types (Magnetic and electrical)" Main stimulation parameters (Current, voltage, etc )" Characteristics (Muscular

More information

Module 3 Causes Of Urinary Incontinence

Module 3 Causes Of Urinary Incontinence Causes Of Urinary Incontinence V4: Last Reviewed September 2017 Learning Outcomes Appreciate the numerous requirements and skills necessary for the person to achieve and maintain urinary continence Discuss

More information

Urinary Incontinence. Vibhash Mishra Consultant Urological Surgeon Royal Free Hospital

Urinary Incontinence. Vibhash Mishra Consultant Urological Surgeon Royal Free Hospital Urinary Incontinence Vibhash Mishra Consultant Urological Surgeon Royal Free Hospital Affects women of all ages Impacts physical, psychological & social wellbeing Impact on families & carers Costs the

More information

Geriatric Urinary Incontinence

Geriatric Urinary Incontinence Geriatric Urinary Incontinence Neil M. Resnick, MD Thomas Detre Professor of Medicine Chief, Division of Geriatric Medicine University of Pittsburgh/UPMC UI: The Problem Prevalence in elderly 33% Morbidity

More information

Management of Urinary Incontinence in Older Women. Dr. Cecilia Cheon Department of Obs. & Gyn. Queen Elizabeth Hospital

Management of Urinary Incontinence in Older Women. Dr. Cecilia Cheon Department of Obs. & Gyn. Queen Elizabeth Hospital Management of Urinary Incontinence in Older Women Dr. Cecilia Cheon Department of Obs. & Gyn. Queen Elizabeth Hospital Epidemiology Causes Investigation Treatment Conclusion Elderly Women High prevalence

More information

Guidelines on Urinary Incontinence

Guidelines on Urinary Incontinence Guidelines on Urinary Incontinence J. Thüroff (chairman), P. Abrams, K.E. Andersson, W. Artibani, E. Chartier-Kastler, C. Hampel, Ph. van Kerrebroeck European Association of Urology 2006 TABLE OF CONTENTS

More information

Normal micturition involves complex

Normal micturition involves complex NEW TARGET FOR INTERVENTION: THE NEUROUROLOGY CONNECTION * Donald R. Ostergard, MD, FACOG ABSTRACT Urine storage and release are under the control of the parasympathetic, sympathetic, and somatic nervous

More information

Ben Herbert Alex Wojtowicz

Ben Herbert Alex Wojtowicz Ben Herbert Alex Wojtowicz 54 year old female presenting with: Dragging sensation Urinary incontinence Some faecal incontinence HPC Since May 14 had noticed a mass protruding from the vagina when going

More information

Case studies: LUTS. Case 1 history. Case 1 - questions. Case 1 - outcome. Case 2 - history. Case 1 learning point 14/07/2015 DR JON REES

Case studies: LUTS. Case 1 history. Case 1 - questions. Case 1 - outcome. Case 2 - history. Case 1 learning point 14/07/2015 DR JON REES Case 1 history Case studies: LUTS DR JON REES A 49 year old male comes to see you he has had gradual deterioration of his flow over the last few years- he saw a colleague of yours 6 weeks ago who recorded

More information

Electrostimulation Part 3: Bladder dysfunctions

Electrostimulation Part 3: Bladder dysfunctions GBM8320 Dispositifs Médicaux Intelligents Electrostimulation Part 3: Bladder dysfunctions Mohamad Sawan et al Laboratoire de neurotechnologies Polystim!!! http://www.cours.polymtl.ca/gbm8320/! mohamad.sawan@polymtl.ca!

More information

Lower Urinary Tract Infection (UTI) in Males

Lower Urinary Tract Infection (UTI) in Males Lower Urinary Tract Infection (UTI) in Males Clinical presentation For patients in care homes see UTI in adults where IV Antibiotics in the community may be appropriate (under development) History and

More information

The Epidemiology and Pathophysiology of Neurogenic Bladder

The Epidemiology and Pathophysiology of Neurogenic Bladder n reports n The Epidemiology and Pathophysiology of Neurogenic Bladder David Ginsberg, MD Neurogenic Bladder: An Introduction Normal micturition (urination) requires proper function of both the bladder

More information

URGE MOTOR INCONTINENCE

URGE MOTOR INCONTINENCE URGE MOTOR INCONTINENCE URGE INCONTINENCE COMMONEST TYPE IN ELDERLY WOMEN Causes: 1 - Defects in CNS regulation Stroke Parkinson s disease Dementia (Alzheimer s and other types) Normopressure hydrocephalus

More information

giovanni.montini@aosp.bo.it VD: definition Voiding dysfunction refers to daytime voiding disorders in children who do not have neurologic, anatomic, obstructive, or infectious abnormalities of the urinary

More information

GBM8320 Dispositifs Médicaux Intelligents. Electrostimulation. Part 3: Bladder dysfunctions

GBM8320 Dispositifs Médicaux Intelligents. Electrostimulation. Part 3: Bladder dysfunctions GBM8320 Dispositifs Médicaux Intelligents Electrostimulation Part 3: Bladder dysfunctions Mohamad Sawan et al Laboratoire de neurotechnologies Polystim!!! http://www.cours.polymtl.ca/gbm8320/! mohamad.sawan@polymtl.ca!

More information

Hong Kong College of Surgical Nursing

Hong Kong College of Surgical Nursing Hong Kong College of Surgical Nursing Higher Surgical Nursing Training: Part B Specialty - Urological Nursing Curriculum TABLE OF CONTENTS No. Contents Page. Introduction. Aims. Learning Objectives 4.

More information

Medical Management of childhood UTI and VUR. Dr Patrina HY Caldwell Paediatric Continence Education, CFA 15 th November 2013

Medical Management of childhood UTI and VUR. Dr Patrina HY Caldwell Paediatric Continence Education, CFA 15 th November 2013 Medical Management of childhood UTI and VUR Dr Patrina HY Caldwell Paediatric Continence Education, CFA 15 th November 2013 Terminology According to the current ICCS terminology guidelines Bladder and

More information

Module 5 Management Of Urinary Incontinence

Module 5 Management Of Urinary Incontinence Management Of Urinary Incontinence V3: Last Reviewed September 2017 Learning Outcomes Outline conservative management options Discover the options available to manage the different types of incontinence

More information

21/03/2016. The urogynaecologist approach. Urinary continence management in women: a multidisciplinary approach. Dr Anna Rosamillia

21/03/2016. The urogynaecologist approach. Urinary continence management in women: a multidisciplinary approach. Dr Anna Rosamillia Urinary continence management in women: a multidisciplinary approach The urogynaecologist approach Dr Anna Rosamillia What is normal bladder function? Incontinence is not normal Normal voiding is 7-8 times

More information

Perineal Electrophysiologic Tests

Perineal Electrophysiologic Tests Perineal disorders and emg! Perineal Electrophysiologic Tests Voiding dysfunction Stress Urinary Incontinence urgency OAB Urge Incontinence nocturia Pr. Gerard Amarenco Mixed Incontinence frequency Service

More information

Prolapse and Urogynae. By Sarah Rangan & Daniel Warrell

Prolapse and Urogynae. By Sarah Rangan & Daniel Warrell Prolapse and Urogynae By Sarah Rangan & Daniel Warrell Anatomy and physiology of the pelvic supports The pelvic floor supports the pelvic viscera and vaginal, urethral and rectal openings Endopelvic fascial

More information

Adult Urodynamics: American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline

Adult Urodynamics: American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline Adult Urodynamics: American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline TARGET POPULATION Eligibility Decidable (Y or N) Inclusion

More information

Dr. Aso Urinary Symptoms

Dr. Aso Urinary Symptoms Haematuria The presence of blood in the urine (haematuria) is always abnormal and may be the only indication of pathology in the urinary tract. False positive stick tests and the discolored urine caused

More information

Neurogenic Bladder: What You Should Know. A Guide for People with Spinal Cord Injury

Neurogenic Bladder: What You Should Know. A Guide for People with Spinal Cord Injury Neurogenic Bladder: What You Should Know A Guide for People with Spinal Cord Injury Why Is This Information Important? Before SCI, you didn t have to think about managing your bladder After SCI, you may

More information

Overactive Bladder in Clinical Practice

Overactive Bladder in Clinical Practice Overactive Bladder in Clinical Practice Alan J. Wein Christopher Chapple Overactive Bladder in Clinical Practice Authors Alan J. Wein Division of Urology University of Pennsylvania Health System Philadelphia

More information

Implementing Clean Intermittent Catheterisation (CIC)

Implementing Clean Intermittent Catheterisation (CIC) Implementing Clean Intermittent Catheterisation (CIC) Julie Dicker (Spina Bifida CNC) Kids Rehab The Children s Hospital at Westmead Reasons for CIC: Neurogenic Bladder CIC is the gold standard for this

More information

TRIUMPH SPINAL CORD INJURY GUIDELINES 2018

TRIUMPH SPINAL CORD INJURY GUIDELINES 2018 TELE-REHABILITATION GUIDELINE Neurogenic Bladder Management in Spinal Cord Injuries Drafted: 2014 Peer Reviewed: February 2018 Finalized: March 2018 70-84% of people with SCI will have some level of bladder

More information

Overactive Bladder. When to see a doctor. Normal bladder function

Overactive Bladder. When to see a doctor. Normal bladder function Overactive Bladder Overactive bladder is a problem with bladder-storage function that causes a sudden urge to urinate. The urge may be difficult to stop, and overactive bladder may lead to the involuntary

More information

Bladder Dysfunction in Multiple Sclerosis. by Nancy J. Holland, EdD, RN and Nancy C. Reitman, MA, RN

Bladder Dysfunction in Multiple Sclerosis. by Nancy J. Holland, EdD, RN and Nancy C. Reitman, MA, RN Clinical Bulletin Information for Health Professionals Bladder Dysfunction in Multiple Sclerosis by Nancy J. Holland, EdD, RN and Nancy C. Reitman, MA, RN Effective bladder management strategies make it

More information

Urinary Continence & Management Post Stroke

Urinary Continence & Management Post Stroke Urinary Continence & Management Post Stroke Incontinence and Stroke occurs in greater than 50% of acute stroke patients despite the personal, economic and psychosocial impact treatment evidence specific

More information

Intravesical Botox Injections

Intravesical Botox Injections Intravesical Botox Injections Department of Urology Patient Information What What is is Botox? Botox? Botox or Botulinum Type-A is toxin produced by bacteria called Clostridium Botulinum. It is given intravesically

More information

LIVING WITH PARALYSIS. Bladder Management

LIVING WITH PARALYSIS. Bladder Management LIVING WITH PARALYSIS Bladder Management CAN WE TALK ABOUT YOUR BLADDER? For most people, when, where and how they re going to go isn t something that s given a lot of thought or planned for in advance.

More information