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Published byMervyn McGee Modified over 9 years ago
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Urinary Obstruction and Stasis Garzon, Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo, Geronimo, Go Section B July 7, 2009
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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
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Physiologic Explanation of Symptoms of Bladder Neck Obstruction
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Bladder Neck Obstruction Hypertrophy of the vesical musculature –Increase in intravesical pressure (50-100 cm H2O) –Overcome resistance caused by the obstructed outlet
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Compensatory Phase Stage of Irritability Stage of Compensation Decompensation Phase Acute Decompensation Chronic Decompensation
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Compensatory Phase Stage of Irritability Stage of Compensation Decompensation Phase Acute Decompensation Chronic Decompensation
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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)
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Earliest Symptoms of Irritable Bladder Urgency → Incontinence Frequency –Both may occur day and night
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Compensatory Phase Stage of Irritability Stage of Compensation Decompensation Phase Acute Decompensation Chronic Decompensation
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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)
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Compensatory Phase Stage of Irritability Stage of Compensation Decompensation Phase Acute Decompensation Chronic Decompensation
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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
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Compensatory Phase Stage of Irritability Stage of Compensation Decompensation Phase Acute Decompensation Chronic Decompensation
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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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