Search

An 81-year-old woman presented with uterine procedentia and incomplete bladder emptying. She initially experienced significant relief of her symptoms with a pessary but developed chronic vaginal bleeding and discharge. She subsequently underwent a LeFort colpocleisis. She presented to the office 7 weeks later complaining of a persistent vaginal discharge and loss of appetite. She was admitted to the hospital and was diagnosed with a pyometra and underwent a supracervical hysterectomy without complications.

Assessment of symptoms plays a central role in the evaluation of men with suspected bladder-outflow obstruction (BOO) secondary to benign prostatic hyperplasia (BPH). It is on the basis of symptoms that treatment designed to relieve outflow obstruction is recommended. However, a variety of studies have suggested that a considerable proportion of men presenting with suspected outflow obstruction are not obstructed as determined by pressure-flow criteria. The relationship between many so-called "obstructive" symptoms and BOO has not yet been defined. Furthermore, all previous studies have defined BOO on the basis of urethral resistance factors, which are now regarded as outdated. Using current concepts of urethral pressure-flow relationships, we studied in detail the relationship between the "obstructive" symptoms of BPH, objective evidence of abnormal voiding and BOO. Only the symptoms of hesitancy and poor flow were found to be significantly related to BOO. The symptoms of straining to void, intermittency, terminal dribbling and feeling of incomplete bladder emptying were not specific for BOO. Objective evidence of an intermittent flow pattern and of terminal dribbling do, however, have a high specificity and positive predictive value for BOO. The assessment of men with lower-urinary-tract symptoms must include objective tests of voiding function. A better understanding of the pathophysiology of lower-urinary-tract symptoms should lead to an improved symptomatic outcome of prostatectomy.

Purpose The voiding of healthy newborn boys shortly after term is dominated by dyscoordinated flow patterns (Olsen et al. J Urol in press) and continues to do so during the first year of life (Olsen et al. J Ped Urol 2008). This study addresses the flow patterns of premature boys. Material and Methods The parents of 29 otherwise healthy premature males accepted to let their child participate in the study. Flow measurements were carried out using an ultrasound flow probe device during a 4-hour observation period. Flow patterns were assessed according to the definitions of the ICCS. Data of 25 boys (median gestational age/weight at birth: 31.3 weeks/1590 g) with 98 micturitions where applicable for analysis. Results are reported as median (range). Results On examination median age was 10 (3-42) days. Flow patterns were bell-shaped in 48%, interrupted in 44%, staccato in 6% and plateau in 2%. In nine of the 47 bell-shaped curves (19%) some fluctuations occurred though not fulfilling the criteria of staccato. None of the premies with more than one recorded micturition had bell-shaped curves only. The number of coordinated flows was not correlated to the age (r2 0.016, P = 0.6). Subjects voided 0.7 (0.2-3.6) times/hour with a volume of 3.9 (0.6-25.2) mL. Median Qmax was 1.0 (0.3-10.0) mL/s. Conclusions Male premies void with a high degree of dyscoordination, small volumes and Qmax values indicating incomplete bladder emptying. Dyscoordinated voiding seems to be part of the natural development of voiding function. This study supports the observations made in mature newborns and during infancy showing maturational voiding coordination.

Menkes’ syndrome, a rare sex-linked disorder of copper metabolism, has been found to be associated with a high incidence of urologic abnormalities. Bladder diverticula were present in 3 of the 4 patients reviewed. Management of incomplete bladder emptying and consequent urinary tract infection is discussed.

In most recent series of artificial sphincter implantations there has been a reduction in mechanical and surgical complications, with continence rates approaching 90 per cent. Despite initially excellent results in 47 children, with increasing durations of followup we noted a transient hydronephrosis related to incomplete bladder emptying in 5 and a persistent physiological alteration of detrusor dynamics consisting of a rigid, noncompliant bladder in 7. Preoperatively, all patients had had in-depth radiological studies and most had a urodynamic evaluation, and were considered to be excellent candidates. The etiology of these alterations is not understood at this time. Bladder and even upper tract deterioration can occur without the appearance of urinary leakage. Therefore, children with an artificial sphincter must be monitored indefinitely with semiannual assessment of the upper tracts and periodic urodynamic evaluation.

Acute urinary retention and overflow incontinence in an older male patient indicate infravesical obstruction by prostatic hypertrophy. Nocturia, frequency, small voided volumes, weak stream, hesitancy, prolonged voiding time, pain, urgency, urge incontinence, postvoiding dribble, and the feeling of incomplete bladder emptying are the symptoms of “prostatism” attributed to chronic urethral obstruction.

Fifty-one patients undergoing abdominoperineal resection of the rectum for carcinoma were studied with regard to bladder function after surgery. Fifty-nine per cent had motor denervation of the bladder due to tumour or operative damage to the pelvic parasympathetic nerves and this produced symptoms of incomplete bladder emptying requiring treatment in 90% of this group. The factors affecting the incidence of nerve damage were discussed. The long-term effect of parasympathetic nerve damage was investigated and the management is discussed.

Using the combined results of oral and intravenous xylose tests, it is demonstrated that 26 percent of a group of geriatric patients absorb from the small bowel less efficiently than younger subjects. The method used excludes poor renal function and incomplete bladder emptying as possible causes for the differences found between the two age groups. Altered gastric emptying is also excluded as a possible factor.