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Urinary Obstruction and Stasis

Urinary Obstruction and Stasis. Garzon, Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo, Geronimo, Go Section B July 7, 2009. Body – major part of the bladder in which the urine collects Neck – funnel-shaped extension of the body

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Urinary Obstruction and Stasis

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  1. Urinary Obstruction and Stasis Garzon, Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo, Geronimo, Go Section B July 7, 2009

  2. Body – major part of the bladder in which the urine collects • Neck – funnel-shaped extension of the body • Detrussor Muscle – its contraction causes an increase in intravesical pressure • Its contraction is the major step in emptying the bladder

  3. Physiologic Explanation of Symptoms of Bladder Neck Obstruction

  4. Bladder Neck Obstruction • Hypertrophy of the vesical musculature • Increase in intravesical pressure (50-100 cm H2O) • Overcome resistance caused by the obstructed outlet

  5. Compensatory Phase • Stage of Irritability • Stage of Compensation Decompensation Phase • Acute Decompensation • Chronic Decompensation

  6. Compensatory Phase • Stage of Irritability • Stage of Compensation Decompensation Phase • Acute Decompensation • Chronic Decompensation

  7. Stage of Irritability • Force and size of the urinary stream normal • Balance between bladder contraction and urethral resistance • Bladder hypersensitive • Strong contractions → spasm • Distension → immediately need to avoid (normally voiding can be delayed)

  8. Earliest Symptoms of Irritable Bladder • Urgency → Incontinence • Frequency • Both may occur day and night

  9. Compensatory Phase • Stage of Irritability • Stage of Compensation Decompensation Phase • Acute Decompensation • Chronic Decompensation

  10. Stage of Compensation • ↑Obstruction, ↑ Hypertrophy = maintain complete bladder emptying • Urgency, frequency + hesitancy • Hesitancy causes px to strain to force the urine through the obstruction • ↑ ↑ Obstruction, ↑ ↑ Resistance = ↓force and size of stream (<20mL/s) = slow vesical emptying near completion (exhaustion of detrusor; end of contraction)

  11. Compensatory Phase • Stage of Irritability • Stage of Compensation Decompensation Phase • Acute Decompensation • Chronic Decompensation

  12. Acute Decompensation • Increased difficulty in urination • Marked hesitancy • Straining to initiate urination • Very weak and small stream • Residual urine • Acute and sudden complete urinary retention

  13. Compensatory Phase • Stage of Irritability • Stage of Compensation Decompensation Phase • Acute Decompensation • Chronic Decompensation

  14. Chronic Decompensation • Increase in residual volume • Frequency • Bladder overstretched and attenuated (1000-3000 mL of urine; normal capacity = 400mL) • Paradoxic/Overflow Incontinence • intravesical pressure = urethral resistance • urine then constantly dribbles forth

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