![]() For many with a significant residual volume, it is impossible to differentiate deficient bladder contractility from outlet obstruction as the primary cause, without a pressure-flow study. If the residual urine volume is significant, its reduction is important in the evaluation of results of treatment of BPO. 74 The Credé maneuver (pressure applied from the umbilicus towards the pubis) and reflex voiding using nonforceful trigger techniques are usually not recommended as they may result in high detrusor pressure and incomplete bladder emptying during voiding. 73 Suprapubic vibration using a mechanical “buzzer” is modestly effective in patients with multiple sclerosis who have incomplete bladder emptying and detrusor overactivity. ![]() 72 Botulinum toxin injections into the external urethral sphincter may improve bladder emptying in patients with spinal cord injury and significant voiding dysfunction. The incidence of symptomatic urinary tract infections is low when catheterization is performed regularly.Īlpha blockers can relax the internal urethral sphincter in men, and although they improve bladder emptying and reduce postvoid residual volumes, their use is usually not recommended unless concomitant prostatic enlargement is present. Neurologic lesions affecting manual dexterity, visual acuity, or cognitive function may require the patient to be assisted by a partner or other provider. Intermittent catheterization is best performed by the patient, who should be taught by an experienced provider such as a nurse continence advisor. Sterile intermittent catheterization was previously the standard, but a clean, rather than sterile, technique has been found to be adequate. There is no consensus regarding the amount of residual volume at which intermittent self-catheterization should be initiated. ![]() The widespread use of intermittent self-catheterization has greatly improved the management of neurogenic bladder dysfunction. 50 This voiding dysfunction can exacerbate detrusor overactivity, and an overactive bladder constantly stimulated by a residual volume responds with contraction, producing symptoms of urgency and frequency, making anti-muscarinic medications less effective. Panicker, in Aminoff's Neurology and General Medicine (Fifth Edition), 2014 Management of Voiding DysfunctionĪ postvoid residual volume of more than 100 ml, or more than one-third of bladder capacity, is considered incomplete emptying. If mechanical obstructions within the urethra or motor symptoms prevent uncomplicated catheterization, a permanent transcutaneuous suprapubic catheter may become necessary ( Fowler and O’Malley, 2003).Īmit Batla Jalesh N. Alternatively, injection of botulinum toxin type A may be helpful in the treatment of detrusor overactivity ( Giannantoni et al., 2009) and urethral hypertonia ( Apostolidis et al., 2009).įinally, postmicturition volumes > 150 mL require clean intermittent catheterization three to four times a day to prevent secondary consequences. Furthermore β-adrenergic receptor antagonists mediate improvements in voiding with reduction of residual volumes in MSA patients ( Sakakibara et al., 2000). More recently, a peripherally acting anticholinergic, trospium chloride, was shown to be equally effective in patients with detrusor hyperreflexia, but with a better tolerability ( Halaska et al., 2003) however, this agent has not been investigated in MSA. Postvoid residual volume in MSA is usually unaltered by procholinergic agents whereas anticholinergic drugs may improve symptoms of sphincter-detrusor dyssynergy and detrusor hyperreflexia early in the course of the disease, although central nervous adverse effects may limit doses ( Beck et al., 1994). Wenning, Florian Krismer, in Handbook of Clinical Neurology, 2013 Urinary symptoms Risks include infection, bleeding, urethral damage, and bladder perforation. Common interventional techniques include stone retrieval, stent placement, tumor biopsy and resection, and laser treatment. Rigid or flexible endoscopic procedures are available. Urinary endoscopy (cystoscopy) provides visual diagnosis and the opportunity for intervention. Urodynamics refers to a battery of tests examining micturition, which may include postvoid residual measurement as well as various tests of bladder and sphincter pressures. Portable ultrasound units can also estimate postvoid residual urine. Less than 50 mL of residual urine is normal, and 200 mL or greater is abnormal (Nitti and Blaivas, 2007). ![]() One method is to have the patient void and then measure any residual urine by catheterization. Postvoid residual measurement assesses the volume of urine in the bladder after voiding and can be performed in the office. Robert Holleman, in Textbook of Family Medicine (Eighth Edition), 2012 Other Diagnostic Tests Postvoid Residual Measurement ![]()
0 Comments
Leave a Reply. |