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-ar observed by the physician including simple means to verify symptoms and quantify them (leakage on coughing)
-frequency volume charts
-pad tests
-quality of life questionnaries
Urodynamic observations
-observations made during urodynamic studies
-are defined by the presence of urodynamic observations associated with characteristic symptoms or signs and /or nonurodynamic evidence of relevant pathologic processes
The three groups of LUTS
-increased daytime frequence
-urinary incontinence
Increased daytime frequency
-sleep disturbing voiding
-to wake at night one or more times to void
Night time frequency
-does not prevent from individual from getting back to sleep
-sudden,compelling desire to pass urine
-which is difficult to defer
Urinary incontinence
-is the compliant of any involuntary leakage of urine
-is the symptomatic compliant of involuntary leakage on effort or exertion
-sneezing or coughing
Urodynamic diagnosis of the involuntary leakage of urine
-during increases in abdominal pressure in the absence of a detrusor contraction
-so-called urodynamic stress incontinence
Urgency UI symptomatic comliant
-of involuntary leakage accompanied by or immediately preceded by urgency as contrasted to urge (which is normal sensation)
Sign of urgency UI
-involuntary urinary loss from the urethra that is accompinied by
-or immediately proceded by urgency
Urodynamic diagnosis of urgency UI
- related to  an involuntary bladder contraction during urodynamics
-so-called detrusor overactivity associated incontinence
Mixed UI urodynamic DS
-involuntary leakage of urine during increases in abdominal pressure
-related to an involuntary contraction during UDS
-present in approximately 40% of women with SI
-or urgency frequency syndrome
-comprises urgency with of without urgency incontinence
-usually with frequency and nocturia
Mixed urinary symptoms
- is a term applied to the presentation of a patient with combination of OAB dry (without urgency incontinence) and stress incontinence
-any involuntary loss of urine
Nocturnal enuresis
-compliant of loss of urine occuring during sleep
Continous UI
-is the compliant of continuous leakage
Other types of UI may be
-situational e.g , the report of incontinence during sexual intercourse,giggle incontinence
Overflow incontinence
-is a term used to describe leakage of urine associated with urinary retention
Postmicturition dribble
-involuntary loss of urine
Extraurethral incontinence
-ectopic ureter
Percent of significant cystocele in women with urethral sphincter incompetence
Pelvic organ prolapse
-descent of one or more of the following:
1.anterior vaginal wall
2.posterior vaginal wall
3.apex of the vagina (cervix/uterus)
4.vault (cuff) after hysterectomy
Anterior vaginal wall prolapse
-descent of the anterior vagina
-so that the urethrovesical junction or any anterior point proximal to this is less than 3 cm above the plane of the hymen
Urethrovesical junction
-a point 3 cm proximal to the external urinary meatus
Prolapse of the apical segment of the vagina
-any descent of the vaginal cuff scar (after hysterectomy) or cervix
-below a point that is 2 cm less than the total vaginal length above the plane of the hymen
Posterior vaginal wall prolapse
-any descent of the posterior vaginal wall
-so that a middline point on the posterior vaginal wall 3 cm above the level of the hymen or any posterior point proximal to this is less than 3 cm above the plane of the hymen
Pts with severe prolapse may develop
-voiding symptoms as a result of urethral kinking
-leading to obstruction
Occult or latent incontinence is
-urethral sphincter incompetence
-masked by the presence of pelvic prolapse
Normal storage of urine is dependent on the
-an intact normally functioning innervated lower tract (bladder,urethra,sphincters,and pelvic floor)
-spinal reflex mechanisms
-tonic inhibitory systems in the brain
Bladder abnormalities that cause UI include
-low bladder compliance
Disordered lower urinary tract function can result
-disruption of the normal peripheral or central nervous system control mechanisms
-disordered bladder muscle function
Disordered bladder muscle function
-primary (unknown pathology)
-is a urodynamic observation characterized by involuntary detrusor contractions during the filling phase
-may be spontaneous or provoked
Detrusor overactivity may be
Phasic detrusor overactivity
-wave form
-may or may not lead to urinary incontinence
-are not always accompanied by any sensation
-may be interpreted  as a first sensation of bladder filling or as a normal desire to void

Terminal detrusor overactivity
- a single involuntary detrusor contraction
-occuring at cystometric capacity
-can not be supressed
-results in incontinence usually resulting in bladder emptying (voiding)
Terminal detrusor overactivity is typically associated with
-reduced bladder sensation (elderly stroke patient when urgency may be felt as the voiding contraction occurs)
Detrusor overactivity incontinence
-incontinence due to nvoluntary detrusor contraction
Neurogenic detrusor overactivity
-replaces the term detrusor hyperreflexia
Idiopathic detrusor overactivity
-replaces detrusor instability
Neurogenic detrusor overactivity causes
-supraspinal neurologic lesions
-suprasacral neurologic lesions
Supraspinal neurologic lesions
-Parkinson disease
-brain tumor
-traumatic brain injury
-multiple sclerosis
Suprasacral neurologic lesions
-spinal cord injury
-spinal cord tumor
-multiple sclerosis
-transverse myelitis
Idiopathic detrusor overactivity
-bladder infection
-bladder outlet obstruction
-prostatic and bladder neck,strictures (men)
-pelvic organ prolapse,postsurgical urethral diverticulum,primary bladder neck,strictures (women)
-bladder tumor,stones,foreign body
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