INCONTINENCE OF URINE
BASIC COURSE OF DIAGNOSIS
Xiaoqi Xu
Renji Hospital
Shanghai Second Medical University
2002.04.19
CONTENT
Definition
Etiology and clinical appearance
Accompanied symptoms
Approach to the patient
DEFINITION
Inability to retain urine in the bladder,result
from neurologic or mechanical disorder of the
system that control normal micturition,
Loss of the urine through channnels other than
the urethra (ectopic ureter,fistulae) and severe
tubercular cystitis (contracture of bladder) are
rare but cause total or continuous incontinence
ETIOLOGY AND CLINICAL
APPEARANCE
True
incontinence
Overflow or
paradoxical
incontinence
Stress
incontinence
Urge
incontinence
True incontinence
The spincter of the bladder and urethra
becomes prone to uncontrolled because
normal pathways are damaged,
diseases of the central nervous system,
cerebrovascular accidents
Alzheimer’s disease
neoplasm
Overflow or paradoxical incontinence
Large residual volumes of urine secondary
to obstruction at the bladder neck or the
urethra (urethral stricture),
benign prostatic hyperplasia
— 75% old man
Stress incontinence
-postmenopausal parous woman
parturition may damage the pelvic support of
the bladder so that the bladder and the urethra
can slip downward from their normal position
above the pelvic diaphragm
the urethra shortens,the normal urethrovesical
angle is lost(closing the urethral sphincter)
women unable to resist the passage of urine
under the stress of increased intra-abdominal pressure
during coughing,sneezing,climbing strains and other
physical activity,small amount of urine escape
Urge incontinence
An involuntary loss of urine associated with
a strong desire to void,
bacterial cystitis
bladder cancer
bladder outlet obstruction
neurogenic bladder
Accompanied symptoms
with progressive straining to void over 50y,
prostatic hyperplasia,prostate cancer
with symptoms and signs in neurologic system,
neurogenic bladder
with irritation sign of bladder and pyuria,
acute cystitis
Approach to the patient
history
Onset,duration,evolution,triggering
events of leakage severity,amount
and type of fluid consumed,sexual
history,past urologic history
physical examination
emphasis on the abdominal,
genital,pelvic,neurologic system
complex testings
DIAGNOSIS
RETENSION OF URINE
BASIC COURSE OF DIAGNOSIS
Xiaoqi Xu
Renji Hospital
Shanghai Second Medical University
CONTENT
Definition
Etiology and clinical appearance
Accompanied symptoms
Approach to the patient
DEFINITION
A variety of lesions can lead to interference with
the normal ability to empty the bladder and to
retain large amount of urine in the bladder,which
is referred to the retention of urine,
Overflow or paradoxical incontinence can occur
with prolonged overdistention of the bladder,
Retention of urine requires to be relieved as soon
as possible to prevent progressive renal damage,
Acute retention of urine
? mechanical obstruction
obstruction at the bladder neck
or the urethra- prostatic
hyperplasia,urethral injury
and stricture,stone,neoplasm,
foreign body,pelvic mass
? dynamic obstruction
dysfunction of micturition
without obstruction of the
urinary tract- anesthesia,
neurologic disorders,
excessive smooth muscle
relaxation from drugs
? miscellaneous
hypokalemia,fever,coma,
stay in bed
Chronic retention of urine
develops slowly,also
produces a dilated and
palpable bladder,but
patients feel less painful-
benign prostatic
hyperolasia,prostatic
carcinoma,bladder cancer
ETIOLOGY AND CLINICAL
APPEARANCE
Accompanied symptoms
with progressive straining to void over 50y,prostatic
hyperplasia,prostate cancer
hematuria,dysuria,discontinuous micturition or
straining to void before the retention of urine,bladder
or urethra stone
asymptomatic hematuria or with irritation sign of
bladder and hematuria before the retention of urine,
bladder cancer
Approach to the patient
history
difficulty in voiding,pain,
hematuria,operation,drug or coma
physical examination
? palpation and percussion of the
abdomen to evaluation the
distention of bladder
? rectal examination-enlargement or
nodularity of the
prostate,abnormal rectal sphincter
tone,rectal or pelvic mass (♀
vaginal,uterine,rectal lesion)
? nervous sysytem
complex testings
DIAGNOSIS
electrolyte analysis,ultrasound,
i.v.pyelography,cystoscopy,
urethrography,CT
BASIC COURSE OF DIAGNOSIS
Xiaoqi Xu
Renji Hospital
Shanghai Second Medical University
2002.04.19
CONTENT
Definition
Etiology and clinical appearance
Accompanied symptoms
Approach to the patient
DEFINITION
Inability to retain urine in the bladder,result
from neurologic or mechanical disorder of the
system that control normal micturition,
Loss of the urine through channnels other than
the urethra (ectopic ureter,fistulae) and severe
tubercular cystitis (contracture of bladder) are
rare but cause total or continuous incontinence
ETIOLOGY AND CLINICAL
APPEARANCE
True
incontinence
Overflow or
paradoxical
incontinence
Stress
incontinence
Urge
incontinence
True incontinence
The spincter of the bladder and urethra
becomes prone to uncontrolled because
normal pathways are damaged,
diseases of the central nervous system,
cerebrovascular accidents
Alzheimer’s disease
neoplasm
Overflow or paradoxical incontinence
Large residual volumes of urine secondary
to obstruction at the bladder neck or the
urethra (urethral stricture),
benign prostatic hyperplasia
— 75% old man
Stress incontinence
-postmenopausal parous woman
parturition may damage the pelvic support of
the bladder so that the bladder and the urethra
can slip downward from their normal position
above the pelvic diaphragm
the urethra shortens,the normal urethrovesical
angle is lost(closing the urethral sphincter)
women unable to resist the passage of urine
under the stress of increased intra-abdominal pressure
during coughing,sneezing,climbing strains and other
physical activity,small amount of urine escape
Urge incontinence
An involuntary loss of urine associated with
a strong desire to void,
bacterial cystitis
bladder cancer
bladder outlet obstruction
neurogenic bladder
Accompanied symptoms
with progressive straining to void over 50y,
prostatic hyperplasia,prostate cancer
with symptoms and signs in neurologic system,
neurogenic bladder
with irritation sign of bladder and pyuria,
acute cystitis
Approach to the patient
history
Onset,duration,evolution,triggering
events of leakage severity,amount
and type of fluid consumed,sexual
history,past urologic history
physical examination
emphasis on the abdominal,
genital,pelvic,neurologic system
complex testings
DIAGNOSIS
RETENSION OF URINE
BASIC COURSE OF DIAGNOSIS
Xiaoqi Xu
Renji Hospital
Shanghai Second Medical University
CONTENT
Definition
Etiology and clinical appearance
Accompanied symptoms
Approach to the patient
DEFINITION
A variety of lesions can lead to interference with
the normal ability to empty the bladder and to
retain large amount of urine in the bladder,which
is referred to the retention of urine,
Overflow or paradoxical incontinence can occur
with prolonged overdistention of the bladder,
Retention of urine requires to be relieved as soon
as possible to prevent progressive renal damage,
Acute retention of urine
? mechanical obstruction
obstruction at the bladder neck
or the urethra- prostatic
hyperplasia,urethral injury
and stricture,stone,neoplasm,
foreign body,pelvic mass
? dynamic obstruction
dysfunction of micturition
without obstruction of the
urinary tract- anesthesia,
neurologic disorders,
excessive smooth muscle
relaxation from drugs
? miscellaneous
hypokalemia,fever,coma,
stay in bed
Chronic retention of urine
develops slowly,also
produces a dilated and
palpable bladder,but
patients feel less painful-
benign prostatic
hyperolasia,prostatic
carcinoma,bladder cancer
ETIOLOGY AND CLINICAL
APPEARANCE
Accompanied symptoms
with progressive straining to void over 50y,prostatic
hyperplasia,prostate cancer
hematuria,dysuria,discontinuous micturition or
straining to void before the retention of urine,bladder
or urethra stone
asymptomatic hematuria or with irritation sign of
bladder and hematuria before the retention of urine,
bladder cancer
Approach to the patient
history
difficulty in voiding,pain,
hematuria,operation,drug or coma
physical examination
? palpation and percussion of the
abdomen to evaluation the
distention of bladder
? rectal examination-enlargement or
nodularity of the
prostate,abnormal rectal sphincter
tone,rectal or pelvic mass (♀
vaginal,uterine,rectal lesion)
? nervous sysytem
complex testings
DIAGNOSIS
electrolyte analysis,ultrasound,
i.v.pyelography,cystoscopy,
urethrography,CT
