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

3. 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

4. Physiologic Explanation of Symptoms of Bladder Neck Obstruction

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

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

7. Compensatory Phase Stage of Irritability Stage of Compensation Decompensation Phase Acute Decompensation Chronic Decompensation

8. 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)

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

10. Compensatory Phase Stage of Irritability Stage of Compensation Decompensation Phase Acute Decompensation Chronic Decompensation

11. 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)

12. Compensatory Phase Stage of Irritability Stage of Compensation Decompensation Phase Acute Decompensation Chronic Decompensation

13. 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

14. Compensatory Phase Stage of Irritability Stage of Compensation Decompensation Phase Acute Decompensation Chronic Decompensation

15. 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